Is Apple’s iMessage HIPAA Compliant?

[Editors note: HIPAA compliance used to be almost the exclusive concern of medical practices and healthcare professional, but the more we digitally zing medical records and patient information around, the more we leave ourselves open to HIPAA violations and their associated fines.]

iMessage text balloon for atricle, Is iMessage HIPAA compliant?iMessage is a go-to technology for Apple users in the medical field because it so easily integrates into pre-existing office infrastructure. Using iMessage for office communication can facilitate quick conversations among office staff–but when it comes to sending and receiving patient data, the question of whether or not iMessage is HIPAA compliant needs to be taken into account.

Some third party apps and Apple Watch health monitoring functions are built to be HIPAA compliant.  However, Apple has yet to address HIPAA compliance on its own iMessage platform. Third party HIPAA compliant messaging and data storage apps have become increasingly popular with iPhone and Mac users in the health care field, but Apple’s iMessage messaging service remains insecure and non-compliant.

HIPAA privacy and security regulation mandates that data transmission of protected health information must be fully secure. Protected health information (PHI) is any demographic information that can be used to identify a patient, including name, address, date of birth, social security number, or full facial photographs, among others.

iMessage uses end-to-end encryption, which means that only the sender and intended recipient can view the contents of each message. But what makes iMessage different than other HIPAA compliant messaging services, is that it keeps a cached version of each iMessage sent on its servers. These cached messages can be accessed either by warrant or by a potential hacker in the event of a data breach.

Although critics in the healthcare IT industry have spoken out against Apple’s practice in this regard, the company has yet to announce a change to this policy. Sending PHI over iMessage remains a breach of HIPAA regulation–putting your practice at risk of a data breach and accompanying HIPAA fine.


Want to Decrease Disability by 53%?

According to a recent issue of Health Affairs, all we have to do is completely eliminate five risk factors: smoking, obesity, diabetes, high cholesterol, and hypertension.

Easy, right?

 graph showing risk factors ofsmoking, obesity, diabetes, high cholesterol, hypertension leading to disabilitiesI find it amazing that these risk factors contribute to (potentially, depending on the credibility you lend the study) more than half of all disability in this country.

And given that the study (Preventing Disability: The Influence of Modifiable Risk Factors On State and National Disability Prevalence) is written from a non-work comp perspective, I view this as more of challenge in our industry (where we accept the whole person and have relatively little influence over pre-injury behavior).

If the theoretical elimination of all five risk factors is a bridge too far for you, consider a more conservative analysis contained in the study: If each risk factor was reduced to the level of the “best performing” state (i.e., if all states mirrored the nation’s lower obesity rate of Colorado), we would observe a decline in disability prevalence of approximately 7%. And disability rates in regions where prevalence is highest (South, Appalachia, and Great Lakes) would drop more than 10% under such a scenario.

But our starting point is grim. In the 18-54 age cohort, nearly 70% of US adults have more than one of the five risk factors. In the 55-64 cohort, it’s about 90%. And in the 65-79 category, about 95%.

This isn’t just clinical, it’s cultural.


Researchers Sound The Alarm On Privacy Policies For Medical Apps

Health apps and privacy policiesHealth apps are integrated into most of our lives. With sensors and user-generated input we can track our steps, fertility cycles, manage chronic conditions, and even find affordable medication. But do you know what the privacy policy is? According to a study by AV-Test, an independent cybersecurity firm based in Magdeburg, Germany, most are not.

In most countries, it’s a legal duty to let the end-user know how any data gleaned is used. Their report found that:

“Of the 60 Android applications examined, a mere 32 offered a direct link from Google’s Play Store to a privacy policy. However, only 22 were available via the link, ten apps led the user nowhere or rather onto orphaned websites. Only 19 out of 60 apps provided a privacy policy directly related to the application evaluated. For 53 out of 60 apps, the existing privacy policy dated back to the year 2014 or even earlier – or there was no information as to when the policy was valid.”

The study also warned about the dangers of clicking “allow,” including giving apps unmitigated access to cameras, microphones, even data from other apps like Facebook.

This problem isn’t just for medical apps, subscription email management platform recently got some very negative press for selling user’s email data to Uber and privacy policies in general are getting a significantly amount of scrutiny lately.


8 Part Email To Send When Transitional Duty Doesn’t Work

Underwater email reading guyDespite your best efforts to get medical restrictions from all treating physicians and evaluate your employee on a weekly basis, there are times when the medical provider says the injured employee can do more than s/he thinks s/he can.

  • For example, a bus driver injured his right arm in a work-related accident. The doctor finds the muscles and bones have mostly healed and the patient should no longer be feeling pain and may return to work for four, rather than an eight-hour day.
  • But in your weekly reviews, the employee complains that opening the bus door is still so painful he cannot drive home at the end of the day.

In this situation, write an email from the injury coordinator to the adjustor asking if a functional capacity evaluation (FCE) may be needed. Also, consider options for alternate work for a while longer.

8 Part Email To Send When Transitional Duty Doesn’t Work

  1. Be sure to include claim number and all relevant addresses and contact information on the letter.
  2. Include the supervisor in any discussions.
  3. Clearly explain the situation: who is injured, what the injury is, what the current complaint is and what the physician says the worker should be able to do
  4. Explain the company’s medical advisor reviewed the reports and the employee’s complaints do not mesh with the current medical diagnosis.
  5. Acknowledge the pain could be imagined (but without judgment) or the result of the employee being fearful of additional injury. Be aware that the pain might be very real also, and don’t minimize the likelihood of this possibility. Anyone who has ever had repetitive arm injury knows how painful it can be and often even a small amount of use can trigger painful symptoms.
  6. Ask your adjustor if an (FCE) is needed and, depending on results, perhaps an off-site work hardening program is in order.  In work-hardening the employee is allowed to build up to his regular job capacity in a supervised setting, removing the fear of re-injury.
  7. Ask the adjustor for suggestions of work-hardening centers in the area.
  8. Acknowledge the difficulty of this claim and ask the adjustor for a timely response.

Real or imagined, pain while doing one’s job benefits neither the company nor the employee.


Smartphone App Detects and Alerts Sleepy Drivers

June 16, 2017.     Source:Hong Kong Baptist University

A green freeway sign with the word Apps on it, symbolizing new app to help prevent fatigue driving, sleepy driving, trucker safety

To reduce accidents caused by fatigue driving, HKBU Computer Science scholar Professor Cheung Yiu-ming and his team have developed a system that detects drowsy drivers and alerts them simply using a generic smartphone.

To reduce accidents caused by fatigue driving, Hong Kong Baptist University (HKBU) Computer Science scholar Professor Cheung Yiu-ming and his team have developed a system that detects drowsy drivers and alerts them simply using a generic smartphone. This invention clinched two top prizes at the 45th International Exhibition of Inventions of Geneva in April 2017. The research team has already submitted a patent application to the US for the system.

The new approach adopts a smartphone’s real-time video to track and analyse the facial features of a driver, in particular the changes in his eyelids and head position, which are prominent fatigue symptoms.

With this system pre-installed in a generic smartphone, a driver just has to put it near the steering wheel with the front camera facing him in his normal driving position. When the camera captures features like drooping eyelids, drowsiness or even nodding off, an alarm is automatically set off. To ensure that the driver is awakened, the driver has to turn off the alarm either by voice or by hand. Continue reading Smartphone App Detects and Alerts Sleepy Drivers

Prescribed DUI: An Alcohol-Free Danger

AKA: Tiger Woods  Syndrome

06/12/17    Dr. Paul Peak

Rx prescription pad with the words, "Don't Drive!"When it comes to getting the attention of the media and the public, not many things work better than an unfiltered, celebrity mugshot. When Tiger Woods was arrested on Memorial Day for driving under the influence, his mugshot and the story of his arrest became easy fodder for the media.

The man once known for being unstoppable on the golf course was found in a stopped car, asleep in the early hours of the morning. While it is easy to assume that anyone arrested for a DUI with a rough looking mugshot like Tiger’s must have been drinking, this was reportedly not the case with Tiger. And it may have been hard to believe when Tiger himself dismissed alcohol as the culprit early on after the news broke. Yet according to the police report, Tiger blew a .000 on his breathalyzer. Tiger was not driving drunk. Tiger was driving drugged. And drugged driving can be just as deadly.

While it’s unclear exactly what regimen Tiger was taking or what drugs led to the interaction (some of the drugs listed on the police report are incorrect as they either don’t exist, are amazingly misspelled, or have been off the market since 2004), this appears to be another example of strong medications used in combination impairing one’s ability to drive.

The one drug listed on the police report that is currently available by prescription only and recognizable is Vicodin, or otherwise known in generic form as hydrocodone in combination with acetaminophen (Tylenol). Vicodin, a commonly prescribed opioid, is known to cause drowsiness, something that is only amplified when given with other medications like a muscle relaxant (a type of medication commonly prescribed after back surgery which Tiger had last month).

Continue reading Prescribed DUI: An Alcohol-Free Danger

Quit Smoking With VR App

Edith Hancock for    Saturday 3 Jun 2017

Smoking is one of the hardest addictions to break.

cardboard VR goggles for smoking cessation VR app
This VR app promises to help you quit smoking (Picture: MindCotine)

Whether you try going cold turkey, ask the NHS for help, or try that god-awful nicotine gum, hundreds of thousands of people all over the world just can’t seem to break that habit and end up relapsing.
It can happen two weeks in or two years, but the urge to smoke is just too powerful for some of us.

Mindfulness and meditation are vital for many people trying to stop smoking, and one U.S. startup have created an app combines the two with Virtual Reality (VR), so you can feel like you’re smoking without ever lighting a cigarette.

Despite the umber of UK smokers falling to an all-time low last year, some 9.4 million still smoke every day, and 100,000 people still die prematurely each year in the UK as a result of heart attacks, strokes and breathing problems caused by smoking.

Mindcotine, a California-based startup, lets you to get all the sensation of smoking without the whole risk of dying thing.

According to its Kickstarter campaign which launched last week, Mindcotine is ‘designed to allow you to surf over your cravings for smoking, while you acquire the skills necessary to face the challenge of relapse.’

Tech whizzes Cristian Waitman, Nicolas Rosencovich and Emilo Goldenhersch spent one month working with the University of Communication producing a prototype of the app, which launched on Kickstarter last week, according to Emilio.

Emilio told that the three founders want to ‘grant a self-empowerment tool to each individual that suffers from this addiction, and grant global accessibility to an integral health solution.’

How does it work?

First, you can pre-order a starter kit via Mindcotine’s Kickstarter page for as little as $10 (£7.75), which contains a cardboard headset designed to turn your phone into a full VR experience..

Next, you download the app. This is where things get interesting.
The app features guided meditation and calming imagery to encourage introspection. Simply place your smartphone in the cardboard headset, stick it over your face and feel the calming vibes wash over you, before going on to an animated smoking experience, complete with sitting down with a cigarette in hand.


Poor Health and Safety Practices Hurt Job Performance

 06/01/17   Simply Work Comp

How do you reduce absenteeism and presenteeism in your employees?

Simpsons workplace safety posterMaintaining a safe workplace and encouraging health and wellness in the workplace may be part of it, according to two recent studies.

CDC measures the cost of chronic conditions

In an October 2016 CDC report, researchers measured the costs of absenteeism in employees with five conditions – hypertension, diabetes, smoking, physical inactivity and obesity.

How costly were the missed workdays? In the billions of dollars.

The researchers estimated that each of the conditions cost employers more than $2 billion per year in excess absenteeism. The most expensive of these, obesity, was calculated at $11.2 billion. In their findings, hypertension caused the most missed workdays per employee and cost nearly $300 per employee per year.

For each condition, employees missed an estimated one to two workdays per year. Those with multiple conditions had more missed days.

Study finds workplace safety impacts job productivity

Another study, published in Health Affairs, measured productivity losses from another angle and found similar results to the CDC report.

The researchers looked at factors such as previous workers’ compensation claims, chronic health conditions and how physically or cognitively demanding a job was to measure health-related productivity losses. They then calculated the predicted costs of absenteeism and presenteeism per person per year.

The study, “Chronic Conditions, Workplace Safety, and Job Demands Contribute to Absenteeism and Job Performance,” found that these factors contributed to both absenteeism and presenteeism. The study was conducted by the Integrated Benefits Institute, Segue Consulting and the Colorado School of Public Health Center for Health, Work and Environment.

While absenteeism was measured in the number of sick hours taken in the last four weeks, the study authors acknowledge that presenteeism can be difficult to measure. They asked employees to rate their poor job performance on a scale from 0 (best) to 10 (worst) and converted the metrics into annual costs. They write, “There is

They write, “There is good reason to believe that presenteeism—when employees come to work but perform at lower levels than usual because of health reasons—often accounts for more lost productivity than absenteeism.”

Study findings:

  • Chronic health conditions and previous workers’ compensation claims contribute to higher absenteeism and presenteeism.
  • Workers with more chronic health conditions had proportionally more cases of absenteeism and presenteeism.
  • Employees with physically demanding jobs reported higher absenteeism, while more cognitively demanding jobs were linked to presenteeism, and “presenteeism is highest when jobs are both physically and cognitively demanding.”
  • The combination of multiple risk factors often led to increased absenteeism and presenteeism, such as employees who had both physically demanding jobs and a workers’ comp claim in the past year.
  •  Employees with none of these factors had lower presenteeism and absenteeism


Soaring Medical Costs From Bicycle Accidents

Billion-dollar toll from injuries, primarily to men

June 1, 2017  Source: University of California – San Francisco

bike versus car highway signBicycle use has skyrocketed in popularity, but it’s also led to more accidents, with medical costs from non-fatal bike crashes climbing steadily by $789 million annually, according to a new study by UC San Francisco.

Over a 17-year period, medical costs of bicycle injuries to adults in the United States, both fatal and non-fatal, amounted to $237 billion, the study found. In 2013 alone, total costs from bicycle accidents exceeded $24.4 billion, the researchers reported. That is approximately double the medical and other various costs involved for all occupational illnesses over the same time period.

There were 3.8 million non-fatal adult bicycle injuries and nearly 9,839 deaths that were reported during the study period from 1997 to 2013. Men accounted for three-quarters of the total costs.

The study will be published June 1, 2017, in the journal Injury Prevention.

“The costs of bicycle injuries have risen steadily since 1997, with a significant increase in emergency department visits and hospital admissions, especially with older men,” said first author Thomas W. Gaither, a UCSF medical student. “In the past, many bicycle accidents stemmed from non-street incidents. But now, street crashes with motor vehicles represent a greater proportion of the total costs. These crashes, which primarily occur with motor vehicles, increase the velocity of the crash impact and, as a result, the severity of the injury.”

Cycling has many well-documented health benefits, including improved cardiovascular function and decreased all-cause mortality. But along with the positive effects of riding, there are risks due to serious and sometimes life-threatening injuries, many involving accidents to riders 45 and older. Previous research by the investigative team has shown that over the last 15 years in the U.S., the incidence of hospital admissions due to bike crashes increased by 120 percent.

Reflecting the major societal implications, the new study estimated total annual costs — including medical costs, work losses and quality of life losses — associated with non-fatal and fatal bicycle injuries to adults. Pediatric injuries were not included. The study analyzed non-fatal incidence data from the National Electronic Injury Surveillance System with cost estimates from the Consumer Product Safety Commission’s Injury Cost Model, and 1999-2013 fatal incidence data from the National Vital Statistics System. The research excluded mopeds and cycles that do not have two wheels.

The investigators calculated costs from a variety of factors, including hospital charges, readmissions, rehabilitation, nursing home stays, emergency transport, visits to the emergency department, days lost, cost of lost work, lifetime productivity lost and lost quality of life.

Among the key findings:

  • The toll for bicycle injuries during the study period was $209 billion for non-fatal accidents and $28 billion for fatal injuries

We Are In A Crisis Of Crap Health News …

… This Week’s Reporting Shows Why

photo of Kevin LomanginoKevin Lomangino is the managing editor of He tweets as @KLomangino.

I can’t remember a week that has featured so much useless reporting about studies that are meaningless to the average reader.

baloney graphic for fake health newsAll the stories featured clickbait-y diet topics like alcohol, chocolate, coffee, and fiber.

All were based on observational studies that can only show associations, not cause-and-effect, and which are prone to drawing conclusions that are later shown to be unreliable.

Most lacked discussion of important study limitations, contained misleading statistics, or otherwise gave readers an incomplete assessment of the research.

I’d call it nothing short of a crisis of crap health news.

Exaggerating benefits and whipping up worry

Not all observational studies are meaningless (e.g., smoking and cancer), and when the associations are big enough and seen often enough, they can wisely be used to guide health recommendations and decision-making.

But this was not the case with any of the studies that were reported on this week.

I can only hope that by calling attention to the problem, more readers will be warned off of these stories and journalists will think twice about covering them — or cover them more skeptically than was the case this week. We offer a primer on writing about observational studies and one that explains the importance of absolute risk figures.

Let’s review.

On Tuesday the big headline was “Just one alcoholic drink a day increases breast cancer risk” — but nobody explained what a “5% increase” might look like using numbers that actually mean something.