4 ms·

> By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of tran

> By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of transmitting patient data imaginable, but it gets the job done. Congrats on the massive process improvement on using readily-available technology. I'm no lawyer but I'm pretty certain that this violates HIPAA, which means it's a new market just screaming for PII-managing image-transfer networks and startups.

__z 11y ago
HIPAA doesn't apply in Germany... PS - its HIPAA not HIPPA.
- stephengillie 11y ago
  No redaction necessary!
- deleted 11y ago
  [deleted]
tgokh 11y ago
The technology exists -- see http://www.physio-control.com/ProductDetails.aspx?id=2147484983 http://www.physio-control.com/ProductDetails.aspx?id=2147484... and http://www.zoll.com/medical-products/data-management/rescuenet-12-lead/ http://www.zoll.com/medical-products/data-management/rescuen... from PhysioControl and Zoll, two of the biggest EMS EKG monitor manufacturers, but its certainly not easy to use. In my system, we used to have to upload the EKG to the computer and then "e-fax" it from he computer to the Emergency Department -- practically, this took 3-4 minutes to do, and when you're in an urban area and nearly always < 10 minutes from the hospital, its not the most productive use of time. Most of the time, if was easier to do the EKG, and in case of a STEMI, call the "code STEMI" via radio, print the EKG and spend the rest of the time doing important patient care (IV access, aspirin, etc) That said, we were in a Paramedic system with a relatively short to-hospital drive time, and going to an academic medical center that had 24/7 in-house interventional cardiologists. If you're in a aystem with only EMT-Basics (who are trained to perform the EKG but cannot interpret the printout), or going to a hospital where the interventional cardiologists need to come in from home, or if your primary hospital doesn't even have a cath lab and will need to divert you to another bigger hospital, it makes a lot of sense to be able to send the EKG from the field and get the ball rolling early.
- maxerickson 11y ago
  Are there procedural hurdles for the reasonably local hospitals to automatically get copies of any emergency EKG being done in the region? There would clearly be some concerns with making sure that the right data was matched up with the right patient, I'm just wondering about how the technology could work, and what the more subtle issues might be.
  - stephengillie 11y ago
    I'm not sure how to approach the topic, but there is competition between hospitals. They are ultimately forced to be businesses and have bottom lines.
  - JshWright 11y ago
    Why would you want to send it anywhere other than the hospital you're heading to?
    - maxerickson 11y ago
      It isn't clear to me that the destination is always strictly determined; in the article, the ER doctor or consulting cardiologist would sometimes divert the ambulance. So the simplest implementation has the copy being easily available at the 'reasonably local' hospitals, rather than having someone push a button to send it to the diversion destination. edit: I see in your other comment that you are talking about scrolling to the correct hospital. It seems less good for the immediately involved technician to spend time on this than for whoever it is at the hospital to do it (I did already mention the caveat about record matching).
      - JshWright 11y ago
        It adds, _maybe_ three seconds to the process of transmitting an EKG. The interface is pretty well designed. It makes more sense for me to be the person making that decision as I am the person with the most complete clinical picture at the time that decision is made. If I'm sending an EKG, I'm also going to be picking up the phone shortly to talk things over with the doc at that ER. There would never be a situation where I don't already know where I'm going before transmitting an EKG.
athenot 11y ago
There are already several HIPAA-compliant messaging apps that take care of that.
loco5niner 11y ago
HIPPA... Germany...
BjoernKW 11y ago
Yes, it is. HIPAA doesn't apply to Germany though, unfortunately. Despite its reputation for privacy Germany's healthcare regulations are severely lacking in that respect. Implementing a more stable - and legal - system for exchanging medical data is next to impossible because there's a bunch of stakeholders who actively undermine what's in the interest of the patients for their own good. So, for the time being, transmitting patient data via WhatsApp and the likes unfortunately - and quite bizarrely - probably is the only option to act in the patient's interest. Besides, the regulators won't notice anyway because for them the Internet still is some passing fad.
oh_sigh 11y ago
HIPAA is a set of American laws, and this is in Germany.
chasb 11y ago
It depends on whether the message/pic is identifiable. If it's not -- just "HEY IS THIS BAD?!" -- then it probably would not constitute protected health information, for HIPAA purposes. (Presuming this is in the US.)
Cass 11y ago
We don't put the patient's name on the EKG, so it's not directly identifiable, and we get their consent before submitting (if they're in any state to consent, which often they aren't), but I'm sure it does violate all kinds of rules and guidelines, if not actual laws.
clsec 11y ago
Though I can't find any reference to it, I'm fairly certain that TextSecure would be HIPAA compliant. I think I'll try to point that out to Moxie and see if they can make it official.

__z 11y ago

HIPAA doesn't apply in Germany... PS - its HIPAA not HIPPA.

stephengillie 11y ago
No redaction necessary!
deleted 11y ago
[deleted]

tgokh 11y ago

The technology exists -- see http://www.physio-control.com/ProductDetails.aspx?id=2147484983 http://www.physio-control.com/ProductDetails.aspx?id=2147484... and http://www.zoll.com/medical-products/data-management/rescuenet-12-lead/ http://www.zoll.com/medical-products/data-management/rescuen... from PhysioControl and Zoll, two of the biggest EMS EKG monitor manufacturers, but its certainly not easy to use. In my system, we used to have to upload the EKG to the computer and then "e-fax" it from he computer to the Emergency Department -- practically, this took 3-4 minutes to do, and when you're in an urban area and nearly always < 10 minutes from the hospital, its not the most productive use of time. Most of the time, if was easier to do the EKG, and in case of a STEMI, call the "code STEMI" via radio, print the EKG and spend the rest of the time doing important patient care (IV access, aspirin, etc) That said, we were in a Paramedic system with a relatively short to-hospital drive time, and going to an academic medical center that had 24/7 in-house interventional cardiologists. If you're in a aystem with only EMT-Basics (who are trained to perform the EKG but cannot interpret the printout), or going to a hospital where the interventional cardiologists need to come in from home, or if your primary hospital doesn't even have a cath lab and will need to divert you to another bigger hospital, it makes a lot of sense to be able to send the EKG from the field and get the ball rolling early.

maxerickson 11y ago
Are there procedural hurdles for the reasonably local hospitals to automatically get copies of any emergency EKG being done in the region? There would clearly be some concerns with making sure that the right data was matched up with the right patient, I'm just wondering about how the technology could work, and what the more subtle issues might be.
- stephengillie 11y ago
  I'm not sure how to approach the topic, but there is competition between hospitals. They are ultimately forced to be businesses and have bottom lines.
- JshWright 11y ago
  Why would you want to send it anywhere other than the hospital you're heading to?
  - maxerickson 11y ago
    It isn't clear to me that the destination is always strictly determined; in the article, the ER doctor or consulting cardiologist would sometimes divert the ambulance. So the simplest implementation has the copy being easily available at the 'reasonably local' hospitals, rather than having someone push a button to send it to the diversion destination. edit: I see in your other comment that you are talking about scrolling to the correct hospital. It seems less good for the immediately involved technician to spend time on this than for whoever it is at the hospital to do it (I did already mention the caveat about record matching).
    - JshWright 11y ago
      It adds, _maybe_ three seconds to the process of transmitting an EKG. The interface is pretty well designed. It makes more sense for me to be the person making that decision as I am the person with the most complete clinical picture at the time that decision is made. If I'm sending an EKG, I'm also going to be picking up the phone shortly to talk things over with the doc at that ER. There would never be a situation where I don't already know where I'm going before transmitting an EKG.

athenot 11y ago

There are already several HIPAA-compliant messaging apps that take care of that.

loco5niner 11y ago

HIPPA... Germany...

BjoernKW 11y ago

Yes, it is. HIPAA doesn't apply to Germany though, unfortunately. Despite its reputation for privacy Germany's healthcare regulations are severely lacking in that respect. Implementing a more stable - and legal - system for exchanging medical data is next to impossible because there's a bunch of stakeholders who actively undermine what's in the interest of the patients for their own good. So, for the time being, transmitting patient data via WhatsApp and the likes unfortunately - and quite bizarrely - probably is the only option to act in the patient's interest. Besides, the regulators won't notice anyway because for them the Internet still is some passing fad.

oh_sigh 11y ago

HIPAA is a set of American laws, and this is in Germany.

chasb 11y ago

It depends on whether the message/pic is identifiable. If it's not -- just "HEY IS THIS BAD?!" -- then it probably would not constitute protected health information, for HIPAA purposes. (Presuming this is in the US.)

Cass 11y ago

We don't put the patient's name on the EKG, so it's not directly identifiable, and we get their consent before submitting (if they're in any state to consent, which often they aren't), but I'm sure it does violate all kinds of rules and guidelines, if not actual laws.

clsec 11y ago

Though I can't find any reference to it, I'm fairly certain that TextSecure would be HIPAA compliant. I think I'll try to point that out to Moxie and see if they can make it official.