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State HIE deployments – Some thoughts from the field

Health and Human Services Secretary Kathleen Sebelius is one busy government employee. From announcements regarding Regional Extension Center Awards and Job Training Grants to the State Health Information Exchange Cooperative Agreement Program, it’s a daunting task to keep up with the acronyms and initiatives.

For the healthcare provider on the front lines, these announcements are just part of several waves of carrot and stick techniques that will ideally drive the U.S. healthcare system toward competitiveness. The carrots have already started coming in terms of grants and incentive payments. State grants (through governor appointed State Designated Entities (SDEs) and state Medicaid agencies) help states improve the exchange of healthcare information which will in turn have many benefits ranging from quality of care to cost reduction.

This sweeping effort reminds me of a huge product development effort on the level of a complex computer system or microprocessor. Given that I have been through more than my fair share of these development efforts, I dug out some notes that I have seen put to very effective use when teams at Intel, IBM and Microsoft and others faced complex endeavors. You might think of these like Stephen Covey’s Seven Habits of Highly Effective People, but for geeks.

1. Focus on tactics, not strategy – Andy Grove, Intel
2. Learn from others – Steve Jobs, Apple
3. Plan to throw one away – Frederick Brooks, IBM
4. Pilot as quickly as possible – Bill Gates, Microsoft
5. Implement in the lab rather that the conference room – Andy Bechtolsheim, Sun
6. Let the most important use cases lead, others will follow – Bill Harris, Intuit
7. Focus on information and users, gain critical mass as quickly as possible – Jeff Bezos, Amazon

But rather than go on and write a book about complex system development process, I thought I would stick to information security and offer a few insights to those that must secure these healthcare information exchanges.

Here are a few things to keep in mind with respect to information security and healthcare information exchange.

• Things will go wrong eventually – have an incident response plan; practice it.
• Make sure you have a CISO. I haven’t met very many in this sector (unfortunately).
• Invest in an information security assessment (yes, I realize it is self-serving).
• Derive policy from security goals and make sure it’s enforceable.
• Develop and maintain a risk management program (the only way to make stakeholders happy).
• Practice business continuity like elementary school fire drills.
• Take a similar approach to security awareness training.
• Review and act on your logs – enough said.
• Develop a threat model – your adversaries are bad, bad.
• Maintain adequate business associate oversight – trust no one.
• Harden your systems, run a patch management program under change control, etc. – this is basic stuff.

There is so much more, but hopefully I have given you a few things to think about.

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