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Electronic Health Records. The US government established a goal of interoperable Electronic Health Records (EHR) within ten years. EHR will enhance records access, save time and improve patient care and safety. At the same time, EHR will place new demands on the institutions' staff, data centers and networks. It also presents new challenges and regulatory burdens in the areas of security and privacy.

HIPAA. The Health Insurance Portability and Accountability Act imposes new rules for healthcare providers who transmit healthcare information in electronic form. HIPAA rules for standardized identifiers and transaction codes that will do much to improve efficiency and access to medical records by unifying previously disparate systems and procedures. On the other hand, HIPAA privacy and security rules greatly restrict how patient information is collected, stored and disseminated. The privacy rule requires safeguards for the disclosure and use of personally identifiable health information. The security rule is designed to protect health information against unauthorized alteration, deletion or transmission.

Supporting applications. While EHR and HIPAAmandated systems are the core components of Healthcare Information Technology , many other electronic applications are needed to implement effective and secure HIT systems. These include:

Integration and Access. Some of the greatest benefits of HIT systems stem from timely and locationindependent access and effective user interfaces. Appropriate care can be provided with a minimum of delay, while reducing the potential for errors like dangerous drug interactions. These integrated applications make critical information available when and where needed in a form that is readily usable by the physician, clinician or administrator.

Wireless Systems. Wireless systems and networks are providing even more convenient and flexible access to medical data. Information can be accessed on the fly while new wireless applications like Radio Frequency Identification (RFID) can seamlessly track key staff, critical materials and controlled substances in real time. New codes may require inbuilding repeaters for Police/Fire/EMS communications. Implementing these systems involves a whole new set of security and performance concerns. The potential for interference from (and with), clinical systems and medical devices like pacemakers is great. Privacy and security demands secure wireless networks, however wireless propagation is insidious. Stray signals can easily leak past poorly designed shielding. Private data may be compromised and federal standards for maximum permissible human exposure to electromagnetic energy may be exceeded.

Data Centers and Networks. The data center and its supporting local and wide-area networks are the most critical elements in HIT. These facilities must achieve levels of performance, reliability, data integrity and security that were never previously attained in the clinical environment.

Many large regional medical facilities will increasingly find economies of scale in backhauling data to centralized, robust data center facilities, via high availability, redundant telecommunications services where data can be safeguarded in secure, mission critical data warehouse facilities. As can be seen in the following figure, the local or remote data center is the hub of all HIT transactions and the associated wired and wireless networks provide the critical application and access links.

Acoustic and Audio Visual Systems. These systems, although not traditionally associated with HIT, also play an important role in the medical institution as technology evolves. AV systems like teleconferencing, telemedicine and patient information/education systems expand and facilitate the HIT user interface while providing new opportunities for the compromise or misuse of patient information. The systems must be designed and maintained to ensure privacy. Even private clinical spaces and public areas must be acoustically designed for speech privacy to protect patient information.

Conclusion. HIT systems must be designed, operated and maintained in a way that balances unprecedented and often conflicting demands for performance, reliability and security. AKF is prepared to assist medical institutions in meeting these goals. We can provide expert advice, design services and field evaluations in the following critical areas.