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How do I report an unsecured Protected Health Information (PHI) Breach?

How do I report an unsecured Protected Health Information (PHI) Breach? | Healthcare and Technology news | Scoop.it

Have you had a HIPAA Breach?  Here's how you report it.

If you are a covered entity and have experienced the loss or theft or accidental disclosure of unsecured or unencrypted Protected Health Information (PHI), you have most likely had a HIPAA Breach. As a covered entity you must undergo specific breach notification procedures as per HIPAA law,  if you discover a breach of unsecured protected health information.  You may need to invoke your incident response plan and involve your attorney depending on the size and nature of the breach.

Step 1- Notify the Secretary of Health and Human Services (HHS)

Your obligations for breach notification to the secretary differ based on whether the breach affects 500 or more individuals or fewer than 500 individuals. If you are unsure how many individuals are affected at the time of submission, provide an estimate.  If the breach affects 500 or more individuals, you need to report the breach to the Secretary no later than 60 days of discovering the breach.

Once HHS receives your breach notification, your information along with some information of the breach will be published on the HHS Breach Portal, also known as the "Wall of Shame".  The Office of Civil Rights (OCR) will then open an investigation.

Step 2- Providing additional information after a breach has been reported

If you discover additional information, submit updates as necessary. If only one option is available in a submission category you should pick the best option, and may provide additional details in the free text portion of the submission.

If you discover additional information that supplements, modifies, or clarifies a previously submitted notice to the Secretary, you may submit an additional form by checking the appropriate box to indicate that it is an addendum to the initial report, using the transaction number provided after submitting the initial breach report.

Step 3- Notify the affected individuals

  1. It is your responsibility to notify each individual of the breach of their PHI, either by notifying them via first class mail, or if they have given permission, you may notify them via email. This notice must include a description of the breach, including the information involved in the breach, steps the individual can take to protect themselves and a summary of the steps you are taking to investigate the breach and what you are doing to prevent future breaches. 

 

What if I don’t have the contact information for Affected Individuals?

 

  1. If contact information for 10 or more individuals is incorrect, you must provide a public notice or media notification in the residential area of those affected individuals, providing them with an 800 number they can call to find out if their information was included in the breach. This number must remain active for a minimum of 90 days.  These individual notices may be substituted by providing notice on your website for a minimum of 90 days or by issuing a media statement notifying the public of the breach.

 

If the Breach Affects 500 or More Individuals:

 

3. If a breach of unsecured protected health information affects 500 or more individuals, you must notify the Secretary of HHS of the breach without unreasonable delay and in no case later than 60 calendar days from the discovery of the breach.  You must submit the notice electronically by clicking on the link below and completing all the required fields on the breach notification form.  

Step 4- Notify the media and update your website 

If the breach affects 500 or more individuals, you need to report the breach to prominent media outlets in the areas where affected or potentially affected individuals reside.  This helps inform all breach victims of the possibility of the exposure of their protected health information.  

If you do not have up-to-date contact information or addresses of 10 or more affected individuals, then you need to update your website with a notice of the breach.  A link to the breach notice must be prominently visible on your home page.

Step 5- Notify HHS annually of breaches affecting fewer than 500 individuals

If a breach of unsecured protected health information affects fewer than 500 individuals, you must notify the Secretary of the breach within 60 days of the end of the calendar year in which the breach was discovered. (You are not required to wait until the end of the calendar year to report breaches affecting fewer than 500 individuals; you may report such breaches at the time they are discovered.) You may report all your breaches affecting fewer than 500 individuals on one date, but you must complete a separate notice for each breach incident. The covered entity must submit the notice electronically by clicking on the link below and completing all of the fields of the breach notification form.

 

Other considerations

  • Be aware that your state may have more stringent breach notification procedures compared to the Federal Government. 
  • Be cognizant of the timeline of breach notification; delays in notification can cause fines and penalties to be levied.
  • Business Associates are also subject to the Breach Notification Rule. Business Associates must inform covered entities within 60 days of discovering the breach.  Business Associates must comply with requirements specified in their Business Associate Agreement with the covered entity.
  • Contact HHS OCR with questions toll-free at: 1-800-368-1019, TDD: 1-800-537-7697 or send an email to OCRPrivacy@hhs.gov
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Cryptomining Malware Can Affect HIPAA Obligations

Cryptomining Malware Can Affect HIPAA Obligations | Healthcare and Technology news | Scoop.it

The well-established security firm Check Point recently ranked cryptomining as the leading cyber-threat in healthcare – ahead of ransomware. Cryptomining malware, also known as cryptocurrency mining malware, refers to software programs and malware components developed to take over a computer’s resources and use them for cryptocurrency mining, without a user’s authorization. This hijacking of computer resources can result in a shutdown and even total systems failure.  Cryptomining is not specifically addressed by the HIPAA security rule. However, the threat of cryptomining malware should make covered entities and business associates evaluate their Security Rule compliance efforts, and, if necessary, implementing additional cybersecurity measures as needed to protect against this unique and powerful threat.

 

Under the HIPAA Security Rule, covered entities and business associates must implement administrative, technical, and physical safeguards to ensure the confidentiality, integrity, and availability of electronically protected health information (ePHI). Cryptomining malware can compromise this confidentiality, availability, and integrity. To understand the nature of the threat posed by cryptomining malware, it is useful to first understand some basic concepts.


These include cryptocurrencycryptography, and cryptomining.

What is Cryptocurrency?

Cryptocurrency is digital money that can be purchased, transferred, and/or sold. Cryptocurrency exists solely on the Internet. This form of currency is not backed by anything tangible (such as gold), nor is it backed or managed by any bank or government. Cryptocurrency transactions, or trades, are changed and verified by a decentralized (not affiliated with anyone single entity) network of computers.

What is Cryptography?

Cryptography is a method of protecting information by encrypting it into an unreadable format known as ciphertext. Ciphertext can be converted to regular text through the process of decryption. Cryptography encrypts and protects the data used to help identify and track cryptocurrency transactions.

What is Cryptomining? 

Cryptocurrency miners engage in cryptomining to earn more cryptocurrency (often referred to as “coins” or “Bitcoins”). 

Here is how the mining process works:

Miners compete with other cryptominers to solve complicated mathematical problems. Solving the problems enables the miner to authorize a transaction and to chain together (blockchain) blocks of transactions. Once a transaction is included in a block, it is secure and complete.

For his or her mining activities, the miner receives a small amount of cryptocurrency of his or her own, The more currency a miner “mines,” the more currency a miner ends up owning. Cryptocurrency can then be sold for actual cash. 

So, you may now be thinking, …..

“What Does Any of This Have to do with HIPAA Health Care?”

Crpyotmining malware is surreptitiously installed on a user’s computer. Once it is installed, the  cryptomining malware turns the affected computer, in effect, into a mining operation – one through which the miners solve their math problems and “earn” their coins and cash.

Here’s the problem: Cryptomining has an enormous appetite for computer power.  As the malware is enabling the mining, the mining process consumes significant computing power, bandwidth, and even electricity.  Particularly persistent forms of malware consume resources even after a user has logged off.   

Eventually, a device or a network may simply become unable to mining malware’s energy requirements, causing the device or network to crash.

Since any Internet-connected device can be infected with cryptomining malware, those devices used by covered entities or business associates that are missing essential security features – which features include, but are not limited to, antivirus software, firewalls, updates and patches for operating systems – can, upon a malware attack, shut down or experience total system failure.  ePHI data thus becomes compromised. As in, lost, rendered inaccessible, or damaged beyond repair. The HIPAA Security rule thus becomes implicated, and, if an organization is found to have implemented ineffective security safeguards, the Department of Health and Human Services’ Office of Civil Rights (OCR) can audit and fine that organization.

Compliancy Group Simplifies HIPAA Compliance

Covered entities and business associates can address their HIPAA cybersecurity compliance obligations under the Security Rule by working with Compliancy Group.

Our ongoing support and web-based compliance app, The Guard™, gives healthcare organizations the tools to address HIPAA cybersecurity issues so they can get back to confidently running their business. 

Find out how Compliancy Group has helped thousands of organizations like yours Achieve, Illustrate, and MaintainTM  their HIPAA compliance!

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These 6 Healthcare Cybersecurity Tips Could Save You Thousands

These 6 Healthcare Cybersecurity Tips Could Save You Thousands | Healthcare and Technology news | Scoop.it

n 2017 alone there were more than 330 data breaches in the US medical and healthcare sector, which exposed 4.93 million patient records.

 

What’s more, data breaches in the healthcare sector are among the most costly with the average breach costing $408 per stolen record. In comparison, the global average of other industries across the world is $148 per record. The medical and healthcare industry in the United States is particularly vulnerable to data breaches. Here are a few reasons why:

  • Healthcare organizations store a high volume of patient records with valuable and private data
  • A lack of mobile security protocols with the BYOD (Bring Your Own Device) trend makes it easier for hackers to breach a network.
  • IoT medical devices and other popular technologies in the healthcare industry like multi-cloud IaaS or SaaS environments provide cybercriminals with more opportunities to hack into a network.
  • The healthcare industry is one of the lowest performing industries when it comes to endpoint security, and the sector as a whole ranks poorly in terms of cybersecurity strength compared to other major industries, making it an easier target for cybercriminals.

 

Chances are you don’t want to spend $50,000 or more in fines for a HIPAA violation, so it’s more critical than ever for you and your healthcare organization to implement the required cybersecurity protocols to ensure you’re protecting sensitive patient data from cybercriminals and hacks.

 

Here’s how you can improve your IT security and make sure you’re implementing healthcare security best practices.

1. Ensure All Employees are Properly Trained

One of the best ways to prevent the risk of data breaches is to make sure all employees and contractors receive the training they need to meet HIPAA requirements and keep data safe.

A proper employee training program will include factors such as:

  • Disaster Response
  • Fire Response (RACE) and Prevention
  • Workplace Violence Prevention and Response
  • VIP Security Control
  • EMTALA (Emergency Medical Treatment and Labor Act)
  • Command Center Operations
  • HIPAA Controls and Compliance
  • Training on The Joint Commission and other Accrediting Bodies
  • Crime Prevention
  • Safety Compliance

What’s more, your training program should go beyond initial training to provide frequent updates to your employees so they can stay on top of the latest trends and threats.

Download the Free HIPAA Regulation Checklist

2. Prioritize Real-Time Evaluation and Response

Want to save your organization thousands of dollars every year? A study by Ponemon Institute discovered that IT teams wasted 425 hours per week trying to solve false negatives and false positives. Healthcare organizations saved an average of $2.1 million yearly by implementing a system where IT teams were able to evaluate security posture in real time, patch all devices for known vulnerabilities, and proactively address emerging threats with data controls and/or patch distribution. This also increases your chances of preventing the risk of an expensive cyber-attack.

3. Leverage the Power of Automation

Since many healthcare organizations are decentralized, it can be more difficult to coordinate software patching and updates. To make sure software updates are fast but thorough, leverage the power of automation where possible to eliminate any vulnerabilities a cybercriminal might exploit.

4. Restrict Access When Needed

Even though employee training is critical, ensuring that your employees can only access sensitive or critical data on a need-to-know basis is another healthcare security best practice.

 

All data should be stored in a centralized location that is protected by a role-based access control system. Those with access should only see what they need to do their jobs and once the information is no longer required access should be removed automatically.

 

Moreover, technologies should be implemented to track and analyze data access as a way to spot suspicious activities.

5. Have a Disaster Recovery Plan in Place

To comply with HIPAA Security, you must have a disaster recovery plan in place and ways to recover and maintain ePHI (electronic Protected Health Information) in case of an emergency. That means you should be backing up all files regularly so data restoration can be quick and easy. A good rule of thumb is to back up your data both locally and remotely (ex: on a recovery disc as well as on a cloud-based server) and you should aim to store all backed-up information away from the main system whenever possible.

6. Encrypt All Data

Data encryption makes sensitive information unreadable, which makes it much harder for cybercriminals to gain access to that data even if a network is hacked or a mobile device is missing or stolen.

 

It’s also important to make sure that all data is encrypted not only when it is at rest (being stored) but also when it is in motion (ex: sending an email). This way sensitive information is protected at all times.

 

Since the healthcare industry is one of the most frequent targets for cybercriminals and one of the most expensive when it comes to addressing a data breach, it’s vital to implement these healthcare security best practices and stay on top of the latest trends in IT security. Help your organization avoid the risk of data breaches and costly fines and give yourself peace of mind knowing that all HIPAA requirements are being met and your patients can trust their sensitive information in your hands.

 

Following these tips will help keep your healthcare company safe and reduce the risk of expensive cybersecurity threats.

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Net Benefits of Telemedicine for Urgent Care Centers

Net Benefits of Telemedicine for Urgent Care Centers | Healthcare and Technology news | Scoop.it

Practice EHR discusses net benefits of telemedicine for Urgent Care Centers.

 

Telemedicine is becoming the new norm for giving and receiving care. Today’s patients are more connected than ever before and 64 percent of Americans report they would seek care via telemedicine, according to an American Well telehealth survey.

 

In its early stages, telemedicine seemed like another on-demand solution taking patients away from urgent care centers (UCCs). Today, urgent cares are realizing the benefits of integrating telemedicine into their operations, such as better flexibility, accessibility and in some cases, better patient satisfaction and outcomes.

 

Fortunately, telemedicine also has financial advantages. Telemedicine empowers UCCs to provide a convenient and cost-effective service for patients, while at the same time improving revenue. Have you considered telemedicine for your urgent care? Read on to learn more about the financial benefits of telemedicine:

Net-Benefits of Telemedicine

1. Increase the number of patients you see each day.

Telemedicine helps you work more efficiently and see more patients in less time. A virtual visit takes less time than an in-person visit, allowing your urgent care to increase the number of patients seen in a day, without having to extend office hours. For example, a clinic with three providers that completes two virtual visits per day, at an average reimbursement of $50, will earn $109,500 in additional revenue in just one year.

 

For UCCs who do feel the need to provide extended office hours, telemedicine is a feasible and cost-effective solution when you have a cloud-based electronic health record (EHR) with integrated telemedicine capabilities. Consider virtual extended hours, where a patient can be seen via a virtual visit conducted by a remote on-call physician. This idea eliminates in-person visits during extended hours, which keeps costs low, drives revenue for your clinic and at the same time provides better accessibility for patients who may be in need during those off-hours

.

2. Better allocate your resources.

Today, consumers have more options than ever before when it comes to their care. Long wait times can result in low patient satisfaction and fewer patients. If your clinic is experiencing long wait times, consider how you can incorporate telemedicine for services that don’t require an in-person visit, like for the flu or an emergency medication refill. Providing virtual visits for these scenarios is a much more efficient and cost-effective way for your patients and your clinic.

 

Telemedicine can also help multi-location UCCs balance their patient volumes and wait times, without having to spend money on additional resources. The Journal of Urgent Care Medicine cited an example of an urgent care that decreased patient wait times and increased patient satisfaction by equipping facilities with telemedicine capabilities in two locations. In other words, UCCs can leverage providers in lower-traffic locations to conduct virtual visits immediately and remotely for patients who are waiting to be seen at the busier location.

 

3. Reach more patients.

In addition to load balancing, telemedicine can easily enable UCCs to reach a larger pool of patients to generate more revenue. Urgent cares who use telemedicine can expand their services to reach patients across one state or multiple, instead of being limited to patients who only live within a 3-5 mile radius.

 

4. Achieve competitive advantage.

Research from Accenture indicates patients want a better healthcare experience and they are leveraging technology, such as telemedicine, to do so. However, the same research also suggests patient demands for virtual care options are outpacing what’s currently available. This provides a significant opportunity for urgent cares. UCCs were the catalysts for convenient, on-demand healthcare; those who continue to evolve with their patients will successfully differentiate themselves in today’s competitive healthcare market.

 

To continue to lead in the on-demand market, urgent care centers will need to adopt technology, like telemedicine to meet patient expectations. The good news is telemedicine is a smart investment that can result in improved efficiency, patient care, cost-savings, revenue and more. Incorporating telemedicine into your UCC isn’t difficult, and there are affordable, telemedicine solutions on the market today. UCCs that incorporate telemedicine, have a lot to gain and very little to lose.

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How to integrate your Phone System with Google Apps through CTI?

How to integrate your Phone System with Google Apps through CTI? | Healthcare and Technology news | Scoop.it

With VoIP (voice over internet protocol), companies are now able to access cheaper, more accessible phone systems all over the world. While VoIP phones have become common, particularly in North America and Europe, there is still a broad growth trend in Asian, African, and Latin American markets. Asian Pacific Markets expect an estimated 14% growth over the next five years, a significant increase considering the dense technological saturation in the area, caused primarily by escalating high-speed communications networks.

 

In markets where there isn’t such an extreme jump in internet infrastructure, there are also significant gains in the adoption of IP phone technology. In Africa, VoIP growth is stunning (80% in South Africa, for example). Because governments own traditional phone infrastructure in Africa, and also because of the challenges expanding utilities to less urban or more isolated areas, mobile VoIP has been replacing traditional phone systems for emerging and growing businesses.

 

Given contemporary global markets and the push toward global expansion, even companies that have long-established traditional phone infrastructure are adopting VoIP systems for their call centers and sales teams. Global calls are more than just person-to-person voice; they now include video, conferencing, and text, whether in Asia, Europe, or North America.

 

With VoIP phone systems, businesses can integrate their phones to their computers and smoothly connect all aspects of sales and service. SMEs and larger enterprises can all benefit from merging data and communications functions; with IP phones, users gain key communication features, all the while letting their VoIP service providers handle IT, updates, and data hosting. Businesses, regardless of size, can benefit from efficiently merging voice and data functions and gaining innovative communication features, while their VoIP service provider takes care of the technology.

 

CTI (computer telephony integration) software lets users integrate their phones with their CRM or ERP platforms to provide more efficient, cheaper, and easier customer communications.

 

With sales, agents can contact more potential clients, improve customer/agent interaction, and create a more collaborative sales team performance. With service, CTI software gives customers options of self-service or live agents, gives automatic call routing, reduces handle times, and gives management the opportunity to review call center performance.

 

It follows by implication that it’s important for businesses to find the best VoIP phone system and CRM for their needs. Some companies need a comprehensive system that works seamlessly across a host of different silos, whereas other businesses need customizable specifics for one element (IT, for example). Businesses must understand their budgets, dominant departments, as well as the need for scalability, and make decisions accordingly.

 
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Do doctors really hate Obamacare?

Do doctors really hate Obamacare? | Healthcare and Technology news | Scoop.it

Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carsontold Fox News that “he’s spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama’s signature health care law.”

Doctors hate Obamacare, it’s alleged, because it authorizes government to “control” the practice of medicine and impose “rationing” of care, thereby harming patients.  The conservative Examiner website quotes a New Jersey family physician, Dr. John Tedeschi as saying, “Just as a guitar string has to be tuned, so does a person’s health to get the right tone. The government has taken away, or refocused the intelligence part of the tuning, and has just about destroyed the creative, or compassion component. Now, with Obamacare, we are left with an incompetent mechanism that does not have the best interest of the patient in mind.”  An ER physician quoted in the articles said that the “storm of patients [created by Obamacare] means when they can’t get in to see a primary care physician, even more people will end up with me in the emergency room.”

There is no question that some doctors (mainly conservatives) hate Obamacare, and if they were the only ones you talked to (like the ones who apparently talked to Dr. Carson), you might think that all doctors feel the same way. But the reality is that — surprise, surprise! — primary care physicians’ views are just like the rest of us, split by their partisan leanings.


A new survey by the respected Kaiser Family Foundation found that 87 percent of Democratic-leaning physicians view Obamacare favorably, while the exact same percentage of GOP-leaning physicians view it unfavorably. Independent doctors split 58 percent unfavorable to 42 percent favorable.  Because there were more GOP and independent physicians among the survey respondents, the overall breakdown of primary care physicians’ views on the ACA is  52 percent unfavorable to 48 percent favorable.  Yet only 26 percent of all primary care physicians viewed the law “very unfavorably. “  So it might be said that just one out of four primary care physicians “hate” Obamacare.

And a deeper dive into the survey results directly refutes the contention of anti-Obamacare doctors that the law is leading to poorer quality, physicians turning away patients, or longer waits for appointments:


  • Most primary care physicians say that quality has stayed the same: 59 percent said that their ability to provide high-quality care to their patients has stayed about the same, while 20 percent said it has improved, and 20 percent said it has gotten worse.
  • More primary care physicians report that Medicaid expansion has had a more positive impact on quality than a negative one: “When asked more specifically about the expansion of Medicaid under the ACA, nearly four of 10 providers (36 percent of physicians and 39 percent of nurse practitioners and physician assistants) said the expansion has had a positive impact on providers’ ability to provide quality care to their patients. About two of 10 said it has had a negative impact, and the remainder said it has not made a difference, or they are not sure.”
  • Ease of getting same-day appointments is about the same as before the ACA: “Overall, about four of 10 primary care providers said almost all their patients who request a same- or next-day appointment can get one; another quarter said most of their patients can get such appointments” which is largely unchanged from 2009 and 2012.
  • Most continue to accept new patients: “A large majority of primary care providers (83 percent of physicians, 93 percent of midlevel clinicians) said they are currently accepting new patients . . . A survey conducted in late 2011 through early 2012 found that 89 percent of primary care physicians were accepting new patients and 52 percent were accepting new Medicaid patients.  This indicates that while physicians’ rates of accepting new patients overall may have declined slightly since the ACA coverage expansions went into effect, acceptance rates for Medicaid have remained about the same.”


When asked specifically about their views on the impact of the Affordable Care Act on five dimensions, the ACA fared well, with one exception (costs to patients).


  • Access to health care and insurance in the country overall: 48 percent positive, 12 percent no impact,  24 percent negative, and 14 percent not sure.
  • Overall impact on practice: 31 percent reported no impact, 23 percent a positive  impact, 36 percent negative  and 9 percent not sure.
  • Quality of care their patients receive: 50 percent reported no impact, 18 percent positive, 25 percent negative, and 6 percent not sure.
  • Ability of the practice to meet patient demand: 44 percent no impact, 18 percent positive, 25 percent negative, and 10 percent not sure.
  • Cost of health care for their patients: 17 percent no impact, 21 percent positive, 44 percent negative, and 16 percent not sure.


However, “physicians’ responses to questions that mention the ACA by name are deeply divided along party lines. For example, by a three-to-one margin, physicians who identify as Democrats are more likely to say the ACA has had a positive (44 percent) rather than a negative (15 percent) impact on their medical practice overall. Republican physicians break in the opposite direction by about seven-to-one (57 percent negative, 8 percent positive).”

The survey also does not support the contention that the ACA is contributing to primary care physician dissatisfaction with practice and burn-out:


“Even though providers with different political affiliations do not share views about the Affordable Care Act, a large majority of primary care providers (83 percent of physicians and 93 percent of nurse practitioners and physician assistants) — both Republicans and Democrats — reported they are very or somewhat satisfied with their medical practice overall. The changing environment does not appear to be affecting overall provider satisfaction even among providers who see a larger share of Medicaid patients or work in Medicaid expansion states. Indeed, current satisfaction levels are slightly higher than what was reported by primary care physicians before the ACA. In 2012, 68 percent of primary care physicians reported they were very satisfied or satisfied with practicing medicine.”


Interestingly, Democratic physicians (56 percent) are more likely to recommend a career in primary care than Republicans (39 percent)  or Independents (40 percent).


I know that many conservative primary care doctors have a strong and principled objection to Obamacare, believing  passionately that it gives the government too much power and the physicians, and their patients will be hurt as a result.  I (and ACP) may not agree with them, but I respect their views, and their right to make their case to their colleagues and to the public.


But the Kaiser Family Foundation survey shows us that the anti-Obamacare doctors do not represent the views and experience of most primary care doctors on the front lines, never mind “all” of them.  Doctors (at least those in primary care, who knows about surgeons?) clearly don’t “hate” Obamacare.  Rather, more of them see Obamacare as doing some good things, like improving access; and doing not as well on other things, like lowering costs to patients.  Much of what they do and see in their practices remains unchanged by it, for good or bad.


And that strikes me about right, Obamacare is making many things better, but there is a lot more that needs to be done to improve quality and access, lower costs to patients, and sustain and support primary care.  Of course, such nuances do not make for as good a headline or political talking point as “Doctors Hate Obamacare.”

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Americans' Risk of Dying From Cancer Is Falling, CDC Finds

Americans' Risk of Dying From Cancer Is Falling, CDC Finds | Healthcare and Technology news | Scoop.it

The risk that any one American will die from cancer -- thecancer death rate -- is going down, regardless of sex or race, a new government study reports.

However, because the United States has a growing aging population, the overall number of people dying from cancer is on the rise, officials from the U.S. Centers for Disease Control and Prevention reported.

"While we are making progress in reducing cancer death rates, we still have real work to do to reduce cancer deaths among our aging population," said lead researcher Mary White, a scientist in the CDC's division of cancer prevention and control.

Between 2007 and 2020, cancer deaths are expected to rise more than 10 percent among men and black women, the report found. Among white women, the number of cancer deaths will start to stabilize, increasing less than 5 percent during this period, according to the CDC researchers.

"Further declines in cancer deaths might be achieved if we can reach other national targets for addressing risk factors," White said.

These include cutting exposure to tobacco and UV radiation, increasing cancer screening for early detection, and improving access to health care to increase early treatment and survival, she said.

White said that a decline in cancer death rates -- even as the actual number of cancer deaths rises -- is not a paradox.

"Death rates are calculated by dividing the number of cancer deaths by the number of people in the population," she explained.

The number of older adults continues to grow, White explained. "Because death rates for many cancers increase with age, the number of people who die from cancer is also predicted to grow, even while death rates decline," she said.

Dr. David Katz, director of the Yale University Prevention Research Center in New Haven, Conn., agreed that reducing cancer deaths and reducing cancer are not the same.

"Cancer death rates are declining markedly, which is excellent news and testimony to the power of early detection and improving treatments," said Katz, who was not involved with the study.

And Dr. Rich Wender, the chief cancer control officer at the American Cancer Society, said, "We have made substantial progress for many of the common adult cancers. The key to that progress is applying research about how to prevent cancer, how to detect it early and treat it effectively."

According to the study findings, between 1975 and 2009, the number of cancer deaths increased 45.5 percent among white men, 56 percent among white women, 53 percent among black men and 98 percent among black women.

These increases are primarily attributed to an aging white population and an increasing black population, White said. This pattern is likely to continue, she added.

The government's Healthy People 2020 initiative set a goal of reducing the rate of cancer deaths by 10 to 15 percent for some cancers by 2020. This target was met for prostate cancer in 2010, the study authors said.

Researchers expect to meet the goal for breast, cervix, colon and rectum, lung and bronchus cancers in 2015. The death rates for cancers of the oral cavity and pharynx seem to be stabilizing, the report said.

However, the goal for melanoma is not expected to be achieved. "It's discouraging to find out that we aren't reducing deaths from melanoma, the most deadly form of skin cancer," White said.

"We know that most cases of melanoma are preventable," she said. "To lower your skin cancer risk, protect your skin from the sun and avoid indoor tanning."

White suggested the people can lower their own risk of dying from cancer by learning about screening tests and other steps they can take to prevent cancer.

"While we have seen improvements to lower cancer deaths, everyone can learn about screening tests and the cancer prevention steps that are right for them," she said.

Katz pointed out that "back in 1981, researchers first highlighted the substantial preventability of cancer by changing one's lifestyle. Most authorities remain convinced that 30 to 60 percent of cancers could be prevented by avoiding tobacco, having a healthy diet, routine activity and weight control."

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New HIPAA Regulations in 2019

New HIPAA Regulations in 2019 | Healthcare and Technology news | Scoop.it

While there were expected to be some 2018 HIPAA updates, the wheels of change move slowly. OCR has been considering HIPAA updates in 2018 although it is likely to take until the middle of 2019 before any proposed HIPAA updates in 2018 are signed into law. Further, the Trump Administration’s policy of two regulations out for every new one introduced means any new HIPAA regulations in 2019 are likely to be limited. First, there will need to be some easing of existing HIPAA requirements.

 

HIPAA updates in 2018 that were under consideration were changes to how substance abuse and mental health information records are protected. As part of efforts to tackle the opioid crisis, the HHS was considering changes to both HIPAA and 42 CFR Part 2 regulations that serve to protect the privacy of  substance abuse disorder patients who seek treatment at federally assisted programs to improve the level of care that can be provided. Other potential changes to HIPAA regulations in 2018 included the removal of aspects of HIPAA that impede the ability of doctors and hospitals to coordinate to deliver better care at a lower cost.

 

These are the most likely areas for HIPAA 2019 changes: Aspects of HIPAA Rules that are proving unnecessarily burdensome for HIPAA covered entities and provide little benefit to patients and health plan members, and those that can help with the transition to value-based healthcare.

How are New HIPAA Regulations Introduced?

The process of making HIPAA updates is slow, as the lack of HIPAA changes in 2018. It has now been 5 years since there was a major update to HIPAA Rules and many believe changes are now long overdue. Before any regulations are changed, the Department of Health and Human Services will usually seek feedback on aspects of HIPAA regulations which are proving problematic or, due to changes in technologies or practices, are no longer as important as when they were signed into law.

 

After considering the comments and feedback, the HHS then submits a notice of proposed rulemaking followed by a comment period. Comments received from healthcare industry stakeholders are considered before a final rule change occurs. HIPAA-covered entities are then given a grace period to make the necessary changes before compliance with the new HIPAA regulations becomes mandatory and enforceable.

New HIPAA Regulations in 2019

OCR issued a request for information in December 2018 asking HIPAA covered entities for feedback on aspects of HIPAA Rules that were overly burdensome or obstruct the provision of healthcare, and areas where HIPAA updates could be made to improve care coordination and data sharing.

 

The period for comments closed on February 11, 2019 and OCR is now considering the responses received. A notice of proposed rulemaking will follow after careful consideration of all comments and feedback, although no timescale has been provided on when the NPRM will be issued. It is reasonable to assume however, that there will be some at least some new HIPAA regulations in 2019.

OCR was specifically looking at making changes to aspects of the HIPAA Privacy Rule that impede the transformation to value-based healthcare and areas where current Privacy Rule requirements limit or discourage coordinated care.

 

Under consideration are changes to HIPAA restrictions on disclosures of PHI that require authorizations from patients. Those requirements may be loosened as they are considered by many to hamper the transformation to value-based healthcare.

 

OCR is considering whether the Privacy Rule should be changed to make the sharing of patient data with other providers mandatory rather than simply allowing data sharing. Both the American Hospital Association (AHA) and the American Medical Association (AMA) have voiced their concern about this aspect of the proposed new HIPAA regulations and are against the change. Both organizations are also against any shortening of the timescale for responding to patient requests for copies of their medical records.

 

OCR is also considering HIPAA changes in 2019 that will help with the fight against the current opioid crisis in the United States. HHS Deputy Secretary Eric Hargan has stated that there have been some complaints about aspects of the HIPAA Privacy Rule that are stopping patients and their families from getting the help they need. There is some debate about whether new HIPAA regulations or changes to the HIPAA Privacy Rule is the right way forward or whether further guidance from OCR would be a better solution.

 

One likely area where HIPAA will be updated is the requirement for healthcare providers to make a good faith effort to obtain individuals’ written acknowledgment of receipt of providers’ Notice of Privacy Practices. That requirement is expected to be dropped in the next round of HIPAA changes.

 

What is certain is new HIPAA regulations are around the corner, but whether there will be any 2019 HIPAA changes remains to be seen. It may take until 2020 for any changes to HIPAA regulations to be rolled out.

Changes to HIPAA Enforcement in 2019

Halfway through 2018, OCR had only agreed three settlements with HIPAA covered entities to resolve HIPAA violations and its enforcement actions were at a fraction of the level in the previous two years. It was starting to look like OCR was easing up on its enforcement of HIPAA Rules. However, OCR picked up pace in the second half of the year and closed 2018 on 10 settlements and one civil monetary penalty – One more penalty than in 2018.

 

2018 ended up being a record year for HIPAA enforcement. The final total for fines and settlements was $28,683,400, which beat the previous record set in 2016 by 22%.

At HIMSS 2019, Roger Severino gave no indications that HIPAA enforcement in 2019 would be eased. Fines and settlements are likely to continue at the same level or even increase.

 

Severino did provide an update on the specific areas of HIPAA compliance that the OCR would be focused on in 2019. OCR is planning to ramp up enforcement of patient access rights. The details have yet to be ironed out, but denying patients access to their medical records, failures to provide copies of medical records in a reasonable time frame, and overcharging are all likely to be scrutinized and could result in financial penalties.

 

OCR will also be continuing to focus on particularly egregious cases of noncompliance – HIPAA-covered entities that have disregarded the duty of care to patients with respect to safeguarding their protected health information. OCR will come down heavy on entities that have a culture of noncompliance and when little to no effort has been put into complying with the HIPAA Rules.

 

The failure to conduct comprehensive risk analyses, poor risk management practices, lack of HIPAA policies and procedures, no business associate agreements, impermissible PHI disclosures, and a lack of safeguards typically attract financial penalties. OCR is also concerned about the volume of email data breaches. Phishing is a major problem area in healthcare and failures to address email security risks are likely to attract OCR’s attention in 2019.

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Cybersecurity: What Every Telemedicine Practitioner Needs to Know

Cybersecurity: What Every Telemedicine Practitioner Needs to Know | Healthcare and Technology news | Scoop.it

Telemedicine, which enables health professionals to provide treatment to patients remotely, is especially useful in rural areas, where people are distanced from healthcare facilities. It can also play a considerable role during natural disasters when professionals cannot reach affected areas or must operate outside of traditional medical settings.

 

But because of the nature of the platform — and the technology used — telemedicine is susceptible to outside attacks, particularly cyberattacks. Communication and digital exchanges are often done via the open internet. A patient will have a live video chat with a health professional via a mobile app, for instance. That feed and any data from the exchange is vulnerable to snooping or outright theft, especially if one of the parties is using an unsecured network connection.

 

Cyberattacks Are More Dangerous in Health Fields

There’s no reason to downplay general theft. The risk of hackers scooping up personal data is always a concern, but when attacks involve highly sensitive health details, the risks are much higher. Not only could the data be used to harm and damage others, but its misuse can also harm the professionals and, by proxy, the facility they work for. HIPAA law dictates that all communications and data exchanged between doctors and patients be secure — if not, healthcare providers face massive fines and penalties.

 

What makes the whole thing even more alarming is that, in today’s landscape, it’s not a matter of “if” you will experience a cyber attack or data breach, but “when.”

Norton Security, which claims "protection against viruses, malware and more," estimates that by 2023, cybercriminals will successfully steal 33 billion records per year.

 

To provide an even better perspective, consider this: By 2018, nearly 70 percent of businesses had experienced some form of cybersecurity attack, with over half experiencing a data breach. Out of all small businesses that suffer attacks, 60 percent close within six months of an event.

 

It’s a very costly, very damaging problem from which the healthcare and telemedicine industry is not exempt.

How to Prevent Attacks and Mitigate Damage When They Do Happen

Preventative measures are important, and understanding how to deal with an attack or breach can be instrumental in lowering risks. Assuming that a breach can and will happen allows you to better lock down your systems and data. For example, putting stringent authentication and user access measures in place help ensure that only the right people can interact with certain types of data. This means if a lesser user’s account were to be hacked, the attacker wouldn’t have access to sensitive information.

The first recommendation is that you follow ISO 27001 standards and develop a process of internal audits to measure compliance and performance. This set of management standards deals specifically with information security and proactive protection measures.

 

Here are some ways to improve general security and mitigate the risks of a breach:

  • Hire a third-party data security provider or a consultant to understand what’s necessary to protect your network, systems and hardware
  • Establish user access protocols to prevent unauthorized users from accessing high-level information; in other words, keep people in their lanes
  • Use strong authentication measures to identify users and require the use of strong passwords
  • Educate personnel on the importance of security and ensure they understand what role they play
  • Use data encryption for all information sharing and open streams so that any exchanged information is locked behind a security protocol
  • Develop the entire platform, app or tool with security in mind as a foundational element
  • Create a response plan for cyberattacks: how you lock down affected systems and networks, prevent future data loss and tampering, and regain control
  • After a breach, always inform the necessary parties involved, including customers and patients, as well as regulatory bodies

 

While many of the solutions discussed here are valuable, many tactics can help telemedicine practitioners prevent and protect against cyberattacks. The most obvious involves awareness and preparedness, which means educating yourself and your personnel on modern security.

 

This is not something that can be continually brushed aside or avoided. Security must always be a “now” practice that is honored and put into place as soon as possible. It’s especially true of for telemedicine, which involves the facilitation and exchange of highly sensitive information across open channels.

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How Relevant CTI Can Be

How Relevant CTI Can Be | Healthcare and Technology news | Scoop.it

CTI stands for Computer Telephony Integration and it refers to any type of technology that allows computer and phone central functionalities to be interconnected resulting in an added value service portfolio.

 

In the beginning of the telephony era, you were not given the chance of dialing; you would simply “signal” a call center and a human operator would ask you what you required. Then once you stated you wanted to call someone, that human operator would establish a point-to-point connection between your terminal equipment (phone) and the destinations.

 

The funny thing is that nowadays, when you ask your smartphone’s personal assistant to call someone, the process as perceived by us humans is, in fact, the same, and we like it better than having to dial the number or look for the contact.

 

Phone Centrals have become Computers instead of the long-gone PBX backbones, nevertheless the integration of such computers (which perform the role of phone centers) with terminal equipment’s which are in fact computers (like smartphones) and computer software like CRM and ERP Servers or Cloud-based App Services has made the CTI concept more relevant by the day.

 
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5 Ways Attackers Are Targeting the Healthcare Industry

5 Ways Attackers Are Targeting the Healthcare Industry | Healthcare and Technology news | Scoop.it

The healthcare industry is one of the largest industries in the United States and potentially the most vulnerable. The healthcare sector is twice as likely to be the target of a cyberattack as other sectors, resulting in countless breaches and millions of compromised patients per year. Advancements in the techniques and technology of hackers and identity thieves could escalate these vulnerabilities into a major crisis if the healthcare industry doesn’t adapt.

Cybersecurity in Healthcare

In 2015, over 113 million patients in the healthcare industry were the victims of an information breach, resulting in lost patient revenue and identity theft. The high volume of cyberattacks on healthcare organizations may be an indicator; the average organization receives 32,000 cyberattacks on a daily basis, a much higher rate than other industries experience. A lack of cybersecurity infrastructure and the high value of personal information makes these organizations likely targets for cybercriminals.

The healthcare industry’s increasing reliance on electronic medical records and internet-connected medical devices means the problem of data breaches could increase in the coming years. In 2017, the estimated total losses from cyberattacks amounted to $1.2 billion, and this number is expected to grow as the attack surface of the healthcare industry increases. The same way consumers and patients have their own resources to protect against identity theft, healthcare organizations need their own systems in place to protect against cyber threats. The following list covers the biggest threats to the industry going forward.

1. DATA BREACHES

The healthcare industry has the highest rates of data breaches out of any sector. Of the 551 data breaches in 2017, 60% were in the healthcare industry. In some cases, hackers have broken into healthcare databases undetected and maintained access for weeks before they were discovered.

The most common types of data breaches are hacking and malware-based attacks. Hackers can sell healthcare data and medical records for over 100 times more than personal data from non-healthcare industries. But not all data breaches are cybersecurity-related; a data leak can also occur through an employee or a lost laptop.

To thwart data breaches, healthcare organizations should ensure that data is encrypted at every point between the patient and an organization’s data storage. Trainings for healthcare staff on data security can also help reduce the number of accidental disclosures.

2. RANSOMWARE

Ransomware attacks tripled in 2017, and the healthcare industry receives more of these attacks than any other industry. A ransomware virus disables a computer or server until a ransom is paid to the hacker. Hospitals use their IT systems for critical patient care, making ransomware potentially life-threatening if it causes a delay in critical care processes.

In 2016, a ransomware attack rendered the hospital network of Hollywood Presbyterian Medical Center inoperable until the administration paid out $17,000 to the attackers. An analysis of the attack showed that the hackers had gained access to an outdated server without using hospital staff as an entry point. Attacks like this demonstrate the importance of a two-part approach to cybersecurity that involves staff training and rigorous network security protocols.

3. SOCIAL ENGINEERING

Hackers looking to exploit a healthcare network’s security system often target hospital staff and other human victims in order to gain access. This type of attack happens through social engineering as a means of subverting even the most rigorous security systems. Phishing attacks, the most common social engineering approach, use a manipulative email to trick a victim into clicking a link or entering their password information. These emails will often download malicious software directly to the system, granting the attacker unlimited access.

Unlike other security threats, social engineering approaches can be combated only through education. Trainings for staff and administrators on identifying a phishing email and avoiding malicious links. Many organizations employ a strategy known as “red teaming,” where trained cybersecurity professionals play the role of attackers and test the organization’s preparedness.

4. DISTRIBUTED DENIAL OF SERVICE ATTACKS

Distributed denial of service (DDoS) attacks are purely disruptive and are a popular tactic for hacktivists who want to shut down a network out of protest, malice or anarchism. These attacks create a coordinated assault from several hundred to several thousand computers, which overwhelm a network or server to the point of inoperability.

In 2014, Boston Children’s Hospital was embroiled in a controversial custody case involving a 14-year-old patient. The sensitive nature of the case spurred the hacktivist group Anonymous to conduct a successful DDoS attack, which resulted in over $300,000 in damage and lost productivity over a one-week period. Healthcare is often connected closely with politics, and it’s likely that DDoS attacks could occur more frequently in the future. Protecting against these attacks requires close coordination with service providers to ensure that critical networks can remain operational under a DDoS onslaught.

5. INSIDER THREATS

A healthcare organization’s cybersecurity system is only as strong as its weakest link. Even the most rigorous cybersecurity network can be bypassed by an insider, making this type of attack one of the most difficult to prevent. Many disgruntled or criminally motivated employees have compromised healthcare organizations by installing entry points to a hospital’s network from the inside.

Insider threats aren’t necessarily malicious. The increasing number of personal devices in hospitals poses an additional insider threat to these organizations. Smartphones, tablets, and laptops are allowed at 81% of healthcare organizations, but only half of these organizations have plans in place to secure these devices. Personal devices are often unencrypted and may be carrying malicious viruses or “worms” that can compromise connected networks.

Cybersecurity is a constantly evolving field. Healthcare organizations must be ready to invest in ongoing security protocols to remain ahead of the most common attacks. Complete security might be impossible, but a reduction in service interruptions and lost data could help healthcare organizations exponentially going forward.

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4 Things to Know About Telehealth

4 Things to Know About Telehealth | Healthcare and Technology news | Scoop.it

Telehealth has emerged as a critical tool in providing health care services. [1] The practice covers a broad range of medical technology and services that collectively define the discipline. Telehealth is especially beneficial for patients who live in rural communities and other remote areas where medical professionals use the Internet to gather and share information as well as monitor the health conditions of patients by using peripheral equipment and software such as video conferencing devices, store-and-forward imaging, and streaming media. The following information details important factors that are shaping this burgeoning field.

 

The Changing Face of Telehealth Law
Today’s competitive health care marketplace has created an environment where patients demand lower costs, higher service quality, and convenient access to services. [2] Telehealth is an innovative and valuable mechanism that provides patients with efficient access to quality services. Lowering costs and removing barriers to service access, are critical components in promoting patient wellness and population health. Convenience and cost-effectiveness are important commodities in the modern health care marketplace, as patients tend to avoid treatment that is difficult to access or too expensive. As a result, telehealth technology is emerging as a preferred choice among patients and providers. Telehealth has also attracted the attention of US legislators. They utilize this tool for improving the competitiveness of American health care services. This is especially important, seeing as health care represents 17 percent of the nation’s gross domestic product (GDP). In fact, the resource has helped to define the role that lawmakers play in ensuring that patients benefit in a competitive health care market.

 

Reimbursement for Services Delivered by Telehealth
The laws regarding reimbursements change regularly as more service providers incorporate telehealth technology into their practices. Reimbursement procedures can vary by state, practice, insurer, and service. [3] Care providers need to understand several facts, regulations, and laws to navigate Medicare telehealth reimbursements. They must first scrutinize whether the distance between the facility (the originating site) and the patient is far enough to qualify as a distant site. The location must also qualify as a Health Professional Shortage Area (HPSA) per Medicare guidelines. Additionally, the originating site must fall under Medicare’s classification as a legally authorized private practice, hospital, or critical access hospital (CAH). For instance, the Centers for Medicare and Medicaid Services ranks the Harvard Street Neighborhood Health Center as a top facility in need of physician services based on these criteria. Care providers must also use proper insurance coding to be reimbursed for hosting services that use telehealth technologies. For now, collecting reimbursements for telehealth services remains simpler for practitioners who limit the scope to which they apply the technology.

 

Telehealth or Telemedicine?
The term ‘telehealth’ is gaining popularity among medical professionals, compared to the original term, ‘telemedicine.’ [4] Some medical professionals use the names interchangeably. However, telemedicine is a term that may apply to the application of any technology in the clinical setting, while telehealth more distinctly describes the delivery of services to patients. Telemedicine is a familiar term, but telehealth more appropriately describes the latest trends in using technology to deliver treatments to patients. Depending on the organization, service providers may use a different definitions of telehealth. Although the basic premise remains similar, the context may change according to factors such as organizational objectives, and the needs of the patient population being served. Medical experts do agree on one point; telehealth is an innovative way of engaging patients, and it is highly beneficial for both providers and patients.

 

The Road Ahead
There are several areas where telehealth medicine could make a significant impact. It could be used as a tool to remotely monitor patients who have recently been discharged. It may also help treat individuals with behavioral health issues who might normally avoid treatment due to its high cost, or to avoid any perceived public stigma. [5] The largest area where technology could advance medicine is in treating the chronically ill. These patients usually require many visits with several specialists who may practice at different and distant originating sites. To move telehealth forward, organizational leaders must present evidence to peers and patients that the technology offers value. In addition, care providers must work to transition patients from using telehealth services only for minor conditions (for headaches, colds, etc.), to accepting the technology as a viable replacement for costly physician office visits. Advocates for telehealth medicine must also develop quality controls, so that this potentially transformational tool can maximize its problem solving capabilities and its service effectiveness. To harness the benefits of telehealth technology, America’s brightest medical professionals (both experienced and up-and-coming) must make a concerted effort to incorporate the tool into their practices and make it a regular service offering. Today’s medical students — as they enter a world where telehealth is becoming more pervasive — can take part in what might be a monumental change in the way health professionals think about medical treatment.

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Ebola-stricken nations need $700 mln to rebuild healthcare

Ebola-stricken nations need $700 mln to rebuild healthcare | Healthcare and Technology news | Scoop.it

Guinea, Liberia and Sierra Leone need a further $696 million in donor funding to rebuild their battered health services over the next two years in the wake of the deadly Ebola epidemic, senior World Health Organization (WHO) officials said on Monday.


WHO Assistant Director General for Health Systems and Innovation Marie-Paule Kieny said that donors had pledged $1.4 billion of an estimated $2.1 billion required by the three countries before December 2017.


U.N. Secretary-General Ban Ki-moon will host an international Ebola recovery conference in New York on Friday to raise additional funds for reconstruction.


More than 500 healthcare staff are among the over 11,200 people killed in West Africa by the worst recorded outbreak of the hemorrhagic fever, which erupted in Guinea in December 2013 and continues to claim lives.


"Full recovery in the three countries will not happen if we don't strengthen the health system," Kieny told a conference call with journalists. She said additional funding would also be required after 2017.


Even before Ebola struck, Guinea, Liberia and Sierra Leone had some of the poorest healthcare systems in the world, but the damage inflicted by the outbreak has left them more vulnerable than ever, officials say.


In Guinea, WHO officials have reported a drastic increase in deaths from malaria and measles. Before the crisis, the country's annual healthcare spending stood at just $7 per person in 2013, one of the lowest rates in the world.


Pre-Ebola healthcare expenditure in Liberia and Sierra Leone was little better at $14 and $11 per person respectively, well below the WHO's recommended minimum of $84 per person per year.


The re-emergence of Ebola in Liberia last week, nearly two months after it was declared free of the virus, has stoked fears that it may take longer than expected to defeat the epidemic.


Kieny said it was too soon to say how the three new cases in Liberia - one of whom has died - became infected. Tests are being carried out by the Liberian government and international health agencies.


The European Union on Monday approved 1.15 billion euros in aid for West Africa through to 2020, nearly doubling its previous commitment to a region that is a major source of migrants seeking to enter Europe.

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Three years on, U.S. Chief Justice Roberts rescues Obamacare again

Three years on, U.S. Chief Justice Roberts rescues Obamacare again | Healthcare and Technology news | Scoop.it

The healthcare law conceived by President Barack Obama and passed by Congress was by no means perfect, U.S. Chief Justice John Roberts said on Thursday. The law, for instance, had "three separate Section 1563s."


“The Affordable Care Act contains more than a few examples of inartful drafting,” the country's top jurist quipped as he announced the court's ruling from the bench preserving the law.


But the imperfections were not the point, he said.

Simply put, the 60-year-old chief justice said, the law was written to make healthcare insurance widely available, and the disputed tax subsidies at the heart of the case were crucial to keeping the cost of premiums down and enrollment up.


It was the second time in three years that Roberts had authored an opinion rejecting a conservative challenge to the 2010 law known as Obamacare.


If a law was ambiguous, it was the job of justices to provide a fair interpretation, he said, as he read from his majority opinion in the marble-columned chamber before some 300 spectators.


His corporate legal experience before joining the bench might have informed his understanding of insurance markets. But the man who cut his teeth in Washington as a lawyer in the government's executive branch also voiced understanding of the messy compromises that accompany bills taken up by the legislative branch.


'TOO COMPLICATED TO UNDERSTAND'


He referred to a cartoon described in 1947 by the late Justice Felix Frankfurter, “in which a senator tells his colleagues, ‘I admit this new bill is too complicated to understand. We'll just have to pass it to find out what it means.’"


Curtailing the subsidies, Roberts said, would lead to an economic "death spiral," with premiums rising and the number of people with insurance dropping.


Unlike three years ago, when Roberts was the only conservative joining the four liberal justices on the nine-member bench to uphold the law, fellow conservative Justice Anthony Kennedy, 78, a 1988 appointee of Republican President Ronald Reagan, signed on with Roberts.


The vote three years ago was 5-4; this time it was 6-3.

In 2012, Roberts drew the wrath of Kennedy, Republicans and other conservatives. Some right-wing advocates beyond the court deemed the 2005 appointee of Republican President George W. Bush a traitor.

Three years ago Roberts confronted a multi-faceted constitutional challenge and stitched together various rationales to uphold the law. His approach on Thursday was straightforward interpretation of statute.


SCOTUSCARE?


In the case decided on Thursday, the challengers, financed by the libertarian Washington-based Competitive Enterprise Institute, had argued that tax-credit subsidies should go only to people who bought insurance on marketplace exchanges "established by the state," as stated in one part of the law.


That reading would dramatically curtail the availability of subsidies because most of the low and moderate income people who qualify live in the nearly three dozen states with exchanges run by the federal government and not the states.


That interpretation also would conflict with the court's usual approach to ambiguous statutes, Roberts said. "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," he said.


Spectators laughed along with Roberts when he quoted Frankfurter, but Antonin Scalia, a 79-year-old justice appointed by Reagan in 1986, was not amused.


Given a Roberts majority had now twice preserved Obamacare, the law might as well be called "SCOTUScare," said Scalia, one of the three dissenters, using the six-letter acronym for the Supreme Court of the United States.

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