The Top Gun of Health Train Express Blogs for 2016 (so far)

Our readership fluctuates quite a bit, averaging a paltry 200-300 users/day. Most of the readership is from the U.S. and the U.K.

This year we had several posts that went well above 1000 readers/day.  Like most internet publications readership depends heavily upon Google searchs.  Readership continues for days, weeks months and even years.  We network our contributions on facebook, twitter Newsana, Digg, Redditr and a list of email subscribers. We have an RSS  feed as well.

Top Gun Posts:

11 TOP PATIENT QUESTIONS ABOUT TELEHEALTH Affordable Care Act causing more mega=-mergers Sleep is not an Option Revised Food and Drug Labels New Hope for Stroke Patients The Senior Learning Network The Five Percent in Health Curing Cancer MentalHealth, Behavioral Health, and Neuroscience. Patients Cannot Always Access Complete Medical Records There were many others receiving between 750 and 950 readers/day.  Our readership continues to grow consistently...thanks for  your interest.

Health IT Cyber Thieves have their own "ENIGMA"` machines

Veterans of World War II will remember the efforts to crack the Japanese encryption used for military communication during WWII.

Enigma was invented by the German engineer Arthur Scherbius at the end of World War I.^[1] Early models were used commercially from the early 1920s, and adopted by military and government services of several countries, most notably Nazi Germany before and during World War II.^[2] Several different Enigma models were produced, but the German military models are the most commonly recognised.

The mechanical/electrical components of the device were easily duplicated. The secret sauce was in the encryption method. 

German military messages enciphered on the Enigma machine were first broken by the Polish Cipher Bureau, beginning in December 1932. This success was a result of efforts by three Polish cryptologists, Marian Rejewski, Jerzy Różycki and Henryk Zygalski, working for Polish military intelligence. Rejewski reverse-engineered the device, using theoretical mathematics and material supplied by French military intelligence. Subsequently the three mathematicians designed mechanical devices for breaking Enigma ciphers, including the cryptologic bomb. From 1938 onwards, additional complexity was repeatedly added to the Enigma machines, making decryption more difficult and requiring further equipment and personnel—more than the Poles could readily produce.

On 25 July 1939, in Warsaw, the Poles initiated French and British military intelligence representatives into their Enigma-decryption techniques and equipment, including Zygalski sheets and the cryptologic bomb, and promised each delegation a Polish-reconstructed Enigma. The demonstration represented a vital basis for the later British continuation and effort.^[3] During the war, British cryptologists decrypted a vast number of messages enciphered on Enigma. The intelligence gleaned from this source, codenamed "Ultra" by the British, was a substantial aid to the Allied war effort.^[4]

What does this have to do with health information technology and mobile health in particular?

Ask Google, since they are planning regular weekly updates to the android operating system.

Google's comment regarding the 'stagefright' hack, 

"This vulnerability was identified in a laboratory setting on older Android devices, and as far as we know, no one has been affected. As soon as we were made aware of the vulnerability we took immediate action and sent a fix to our partners to protect users...As part of a regularly scheduled security update, we plan to push further safeguards to Nexus devices starting next week. And, we'll be releasing it in open source when the details are made public by the researcher at BlackHat."  How to see if your Android Device is vulnerable to the Stagefright hack ?

Google's Android Blog  "Nexus devices will continue to receive major updates for at least two years and security patches for the longer of three years from initial availability or 18 months from last sale of the device via the Google Store."

In recent months many breaches have been reported by health insurers. In most instances medical records were not accessed other than an attempt to gather consumer identification and credit information. Identity theft is a major concern.

The moral of the story is that security breaches will be present for a long time. Thieves are inventive.

Where People go to look for Medical Information on the WWW

Everyone is doing it. Patients do it, physicians do it, and family members do it.



For the current generation (Millenials, Gen-X) the use of the internet and familiarity with search is a sine-qua-non. They have used it in school, most likely beginning in elementary school. It has become an educational staple, much like learning your ABC and/or multiplication tables.

One of the key ingredients is to  know where to search for what. A simple Google search will result in thousands of results, which is not much help in the long run. Google's search engine optimization is not built for research. It is a marketing tool based on several algorithms to  analyze who watches what, and if they return.

The PEW Internet Project evaluated internet usage in depth, by illnesss, chronic disability, age, other demographics

Health Fact Sheet

Highlights of the Pew Internet Project’s research related to health and health care.

A key ingredient is the ease of access to this information:

90% of U.S. adults own a cell phone; 58% of U.S. adults own a smartphone (January 2014 survey). For more, see: Mobile Technology Fact Sheet

87% of U.S. adults use the internet (January 2014 survey). For more, see: Internet User Demographics

Online health information:

72% of internet users say they looked online for health information within the past year.

• This is based on a September 2012 survey, the first time we asked people to think only about their online health activities in the past 12 months. For historical perspective, see: Health Topics and Who Doesn’t Gather Health Information Online?

77% of online health seekers say they began their last session at a search engine such as Google, Bing, or Yahoo. Another 13% say they began at a site that specializes in health information, like WebMD. Just 2% say they started their research at a more general site like Wikipedia and an additional 1% say they started at a social network site like Facebook.

The most commonly-researched topics are specific diseases or conditions; treatments or procedures; and doctors or other health professionals.

Half of online health information research is on behalf of someone else – information access by proxy.

26% of online health seekers say they have been asked to pay for access to something they wanted to see online (just 2% say they did so).

Clinicians remain a central resource:

When asked to think about the last time they had a serious health issue and to whom they turned for help, either online or offline:

• 70% of U.S. adults got information, care, or support from a doctor or other health care professional.
• 60% of adults got information or support from friends and family.
• 24% of adults got information or support from others who have the same health condition.

People turn to different sources for different kinds of information:

When people have technical questions related to a health issue, professionals hold sway. When a situation involves more personal issues of how to cope with a health issue or get quick relief, then non-professionals are preferred:

Technology Revolution

Three major technology revolutions have occurred during the period the Pew Research Center has been studying digital technology – and yet more are on the horizon.

Broadband

First, the rise of the internet changed the way that people got information and shared it with each other, affecting everything from users’ basic social relationships to the way that they work, learn, and take care of themselves. The speed of internet connectivity picked up considerably with the rise of broadband connections. As people adopted those higher-speed, always-on connections, they became different internet users: They spent more time online, performed more activities, watched more video, and themselves become content creators.

Second, mobile connectivity through cell phones, 

and, smartphones and tablet computers, made any time-anywhere access to information a reality for the vast majority of Americans. Mobile devices have changed the way people think about how and when they can communicate and gather information by making just-in-time and real-time encounters possible. They have also affected the way people allocate their time and attention.

                                                               Social

Third, the rise of social media and social networking has affected the way that people think about their friends, acquaintances, and even strangers. People have always have social networks of family and friends that helped them. The new reality is that as people create social networks in technology spaces, those networks are often bigger and more diverse than in the past. Social media allow people to plug into those networks more readily and more broadly – making them persistent and pervasive in ways that were unimaginable in the past. One of the major impacts was that the traditional boundaries between private and public, between home and work, between being a consumer of information and producer of it were blurred.

Health Care Social Media is a in social media. The use of hashtags allows anyone to search on twitter for specific diseases, treatments, and more including twitter postings from scientific meetings, ie #AMA2015, or #AAFP2015. This allows any twitter user to receive tweets from the specific meeting, filtered out from the twitter stream.

This last category  has potential to be the most important. Facebook pages, Google plus pages offer a visible and easily accessed methodology to 'llke" "follow" or + topics of interest. Many of these sites come directly from a hospital and/or clinic. 

Static web pages are fixed in content. A web page coupled with an active daily or weekly social media posting using hashtags as a search modality gives both user and patient an active inter-action.

These formidable changes have not been limited to healthcare. Health professionals were lagging in interest possibly due to the issues of privacy and confidentiality.  HIPAA clearly defines the limits of information in regard to personal identification placed in a public space, accessible to anyone. 

Access to these high speed resoures remains limited however in many rural and some suburban areas due to the unavailability of modern broadband resources. The development of high speed 4G, and LTE cellular networks is also lacking in some areas. Profitability and a business model for those regions remains a paramount barrier.

Who is not using modern technology to access health information?