Tag Archives: private networking

The Private Social Network for healthcare

In his post on the Pathcare blog, I trust you to keep this private, Danny Lieberman talked about the roles that trust, security and privacy play in online healthcare interactions. In this post, Danny talks about healthcare privacy challenges in social networks and describes how to implement a private social network for healthcare without government privacy regulation and IT balls and chains.

Online interactions with our HMO

We have online interactions with our healthcare organizations; accessing a Web portal for medical history, scheduling visits etc. Our PHI (protected healthcare information) is hopefully well-secured by our healthcare provider under government regulation (HIPAA in the US, and the Data Protection Directive in the EU). Albeit in the name of privacy, healthcare providers often take security to absurd extremes, witness the following anecdote:

I tried using online medical services with my provider in Hawaii but they could not respond due to my not being in Hawaii. What good is online diagnostic services when the patient is not in his/her home state?

Well now, I thought, that’s why Al Gore invented the Internet so that we could access healthcare services anywhere, anytime. Guess not. With our healthcare provider, we interact with the IT department. Bummer. On Facebook we interact with our friends. Compassion.

A healthcare provider’s business model requires them to protect your health information from disclosure. This is generally interpreted as doing as little as possible to help you be healthy. Social media business models require them to maximize distribution of your content. This means that your privacy is up to you and the people you connect with.

It seems obvious to me, that privacy regulation cannot work in social media because the connectivity is so high. There is no central data center where you can install an IPS and DLP systems and implement all of HIPAA CFR 45 Appendix A administrative, physical and technical safeguards. In that case, let’s get back to basics. We agree that privacy in our healthcare interactions is critical.

What is privacy?

pri·va·cy/ˈprīvəsē/

  1. The state or condition of being free from being observed or disturbed by other people.
  2. The state of being free from public attention

Healthcare privacy by design

Just like you are alone with your doctor in his office,we can build a private social network where the topology of the network guarantees privacy. We describe a star topology where one doctor interacting with many patients. We guarantee online privacy in our star topology network with 3 simple principles;

  1. Each doctor has his own private network of patients.
  2. In the private network, patients do not interact with other patients (interact as in friending, messaging etc.). We can expand the definition a bit by allowing a patient to friend another person in a caregiver role, but this is the only exception to the rule.
  3. A doctors private network does not overlap with other doctor networks, although doctors connect with each other for referrals.

This is a private network for healthcare by design.

What makes it a private social network, is the use of the same social apps we use in social media like Twitter and Facebook: friending, short messaging, status updates, groups, content sharing and commenting/liking.

A doctor uses a private social network for healthcare with the same 3 basic primitives of public social networking: Connect (or friend), Follow and Share.

One of the things that excites me the most about private social networks for healthcare is the potential to make the information technology go away and put the focus back on the patient-physican interaction and quality of clinical care.

  • Doctors save time in interviews because patients can record events and experiences before they come in to the office.
  • Data is more accurate since patients can record critical events like falls and BP drops, in proximity to the event itself.
  • Better data makes physician decisions easier and faster.
  • Better data is good for health and easier and faster is good for business.

What a beautiful business model – compassion, care and great business!

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How to keep secrets in healthcare online


The roles of trust, security and privacy in healthcare.  If President Obama had told his psychiatrist he was gay, you can bet that it would be on Facebook in 5′. So much for privacy.

pri·va·cy/ˈprīvəsē/

Noun:

The state or condition of being free from being observed or disturbed by other people.

The state of being free from public attention

When it comes to healthcare information, there have always been two circles of trust – the trust relationship with your physician and the trust that you place in your healthcare provider/insurance company/government health service.

With social networks like Facebook, a third circle of trust has been created: the circle of trust between you and your friends in the social network.

Patient-doctor privacy

When we share our medical situation with our doctor, we assume we can trust her to keep it private in order to help us get well. Otherwise – we might never share information regarding thoses pains in in the right side over our abdomen, and discover after an ultrasound has been done, that our fatty liver is closely related to imbibing too many pints of beer and vodka chasers with the mates after work – when you have been telling the missus that you are working late at the office.

Healthcare provider – patient privacy

When we share medical information with our healthcare provider, we trust their information security as being strong enough to protect our medical information from a data breach. Certainly – as consumers of healthcare services, it’s impossible for us to audit the effectiveness of their security portfolio.

With our healthcare provider, revealing personal information depends on how much we trust them and that trust depends on how good a job they do on information security, and how effectively they implemented the right management, technical and physical safeguards.

If you’re not sure about the privacy, trust and security triangle, just consider Swiss banks.

Millions of people have online healthcare interactions – asking doctors questions onlines, sharing experiences in forums, interacting with doctors using social media tools like blogs and groups and of course – asking Dr. Google.

Privacy among friends

When we share medical information with our friends on Facebook/Google+ or Twitter we trust them to keep it private within our own personal parameters of vulnerability analysis.

Note that there is feeling secure (but not being secure – chatting about your career in crime on Facebook) and being secure while not feeling secure (not wanting to use your credit card online – face it, with over 300 million credit cards breached in the past 5 years, chances are, your credit card is out there and it doesn’t seem to make a difference now, does it?).

Trust between 2 people interacting (whether its face-to-face or on Facebook) is key to sharing sensitive information, since it mitigates or eliminates the damage of unexpected disclosure.

Let’s illustrate the notion of personal trust as a security countermeasure for unexpected disclosure with a story:

Larry interacts with his lawyer Sarah regularly, once a week or more. It’s a professional relationship, and over time, Larry and Sarah gain each others trust, and in addition to contracts and commercial terms and conditions, the conversations encompass children, career and life. Larry knows Sarah is divorced and is empathetic to the challenges of being a full-time mother and corporate lawyer. Come end of year, Larry sends Sarah a box of chocolate wishing her a successful and prosperous New Year. Sarah’s 14 year old daughter, who is pushing her to start dating again, sees the gift package and draws conclusions that Mom has a new beau. Sarah now has to go into damage control mode with a teenage daughter. It may take Larry months (if ever…) to regain the trust of his colleague. This is literally the damage of unexpected disclosure of private information.

Unlike a healthcare provider, on Facebook we only interact with our friends.

We have digital interactions with our healthcare provider, accessing a Web portal for medical history, scheduling visits and lab tests online etc. These are interactions unrelated to the personal relationship with our physician. The data in these interactions is regulated by governments and secured by healthcare provider information security organizations.

Your healthcare provider’s business model requires them to protect your health information from disclosure.

In our digital interactions on Facebook or Twitter,  there is no organizational element to the security, trust and privacy equation only the personal element. This is because your Gmail, tweets and Facebook conversations are the content that drives Google, Twitter and Facebook advertising revenues.

Social media business models require them to distribute as much of your content as possible.

So, is there a reasonable solution to ensure private healthcare interactions on social networks?

The answer,  I believe, lies in getting back to the dictionary definition of privacy, and creating a private social network for healthcare that enables you, your doctor and family to “be free from being observed or disturbed by other people”.

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Anatonme – a hand held device for improving patient-doctor communications

From a recent article in Healthcare Global.

Studies suggest that 30-50 percent of patients are likely to give up treatments early.  Microsoft Research has developed an innovative, hand-held medical device called Anatonme to help patients understand their issue and complete their treatment plan more often.

We’ve been doing research and development into private, controlled social networking to reinforce private communications between doctor and patient. It’s gratifying to see Microsoft Research doing work in this area.

Private social networking for doctors and patients provides highly effective secure data sharing between doctors and patients. It allows patient-mediated input of data before visits to the office, making the clinical data more accurate and complete and boosting the trust between doctor/healthcare worker and patient.

A private social network has a controlled 1 to N (doctor to patients) topology and physiological and emotional context, unlike Facebook that has a distracting social graph and entertainment context.

A private social network for doctors and patients also provides powerful information exchange and search:

  1. Capture critical events on a timeline (for example blood pressure, dizziness etc) that enables the doctor to respond in a timely fashion.
  2. Reconciles differences between what the doctor ordered and what the patient did.
  3. Granular access control for sharing of data between doctor, patient and referrals.

If you’re interested in hearing more – contact us.

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Lies of social networking

Is marketing age segmentation dead?

My sister-in-law Ella and husband Moshe came over last night for coffee. Moshe and I sat outside on our porch, so he could smoke his cigars and we rambled over a bunch of topics, private networking,  online banking and the Israeli stock market.  Moshe grumbled about his stock broker not knowing about customer segmentation and how he used the same investment policy with all his clients.   A few anecdotes like that and I realized:

Facebook doesn’t segment friends

There is an outstanding presentation from a person in google research discussing this very point – a lack of segmentation in social networks:

http://www.slideshare.net/padday/the-real-life-social-network-v2

Almost every social networking site makes 4 assumptions, despite the fact that there is ample evidence that they’re wrong.

  1. Your friends are equally important
  2. Your friends are arranged into discrete groups
  3. You can manage hundreds of friends
  4. Friendship is reciprocal and equal

 

In fact :

  1. People tend to have 4 – 6 groups
  2. Each group has 2-10 people
  3. There are strong ties and weak ties.
  4. Strong ties are always in the physical world are < 6
  5. Weak ties in a business context are  < 150

 

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Private social networking for healthcare

I think we’re rapidly approaching a  point in time where people will pay for privacy.  I know that after a super-hot month of August with the house full of kids chain-watching Ratatouille, I would pay someone for some privacy.

The privacy controls that governments are attempting to impose on social media and the technical safeguards that social networks like Facebook are implementing seem to be band-aids on a larger and much more significant two-part problem

  1. How to enable individuals to control the information they disclose?
  2. How to enable individuals to put their value in front of their social graph?

I believe that the brunt of the public debate has been on question number 1 – primarily because of the sheer size and entertainment/leisure time/socializing/shmoozing/networking elements of Facebook and LinkedIn and other social media web sites.  As Bruce Schneier has noted in some of his recent essays – privacy on the Net is not necessarily about forbidding disclosure  (like the regulators are trying to do with PII and PHI compliance regulation) but about controlling what you share.

But  entertainment, leisure time, socializing and networking are not everything in life – and as a matter of fact – most people go to work and either create, make, sell or buy for a living.   Question number 2 is about increasing your disclosure in a controlled way and putting your value forward to your customers and not behind the company that you represent. Value backwards (as opposed to value forwards) is the way most information technology and big pharma is sold today – you work for a security integrator and you’re reselling someone else’s product extolling the virtues of Websense DLP (like 10 other resellers in your geography) or you’re a medical sales representative for MSD and you’re extolling the advantages of Remicade for treating Crohn’s disease.

But – we all know that the reason the customer is talking to you is because he values you (or thinks you might have something of value to sell).

Last year we did a private, professional networking project for one of the big 3 innovative pharmas at one of their Central European offices. It was a successful clinical trial of what we thought was a good idea – enabling medical sales representatives to place their value in front of their social graph of doctors.   As we approach release of the beta version of a productized version – it seems time to get some feedback on the notion of private, controlled networking. So here it is – feel free to comment online or email me.

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