Medical Records Optimization

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Last friday, I was googling for casemix for a future post when I stumble upon the announcement by The International Centre for Casemix and Clinical Coding (ITCC), UKM Medical Centre, Universiti Kebangsaan Malaysia (UKM), Malaysia which was planning to organise the 6th International Casemix Conference 2012 (6ICMC2012) from the 6th -7th June 2012  in Kuala Lumpur , Malaysia.

Reading through this announcement, I noticed for the first time the words “Medical Record Optimization”.  The organiser was calling for invitations from local and international participants to attend and present their findings and papers in several areas, including on Medical Record Optimization.

I abandoned my search for casemix (after surfing briefly some casemix websites) and decided to find out what Medical Record Optimization was all about and blog about it soon after as in this post before you. More googling and reviewing my search led me to locate MedNeutral which stood out prominently in the search list.

MedNeutral which has its roots in the insurance industry is a Brahma Holdings company which provides transformational solutions to the insurance industry in the United States of America, is headquartered in La Jolla, CA, USA.

MedNeutral’s proprietary Medical Records Optimization™ (MRO) solution is a next-generation service comprising of a set of digital medical record solutions that performs a triage on the medical records for claims processors, legal counsel, financial personnel, medical professionals, and government agencies.

As you will be aware in the Malaysian hospital setting, medical records contain extremely important information for claims processing, and also for data analytics. As Health Information Management (HIM) / Medical Records (MR) practitioners still dealing with paper-based medical records in most of Malaysia’s public and private hospitals (as in most parts of the developing world and under-developed world regions), something as basic as illegible handwriting is still the biggest problem in paper-based medical records. Other challenges in paper-based medical records include the absence of medical context, missing or incomplete documentation, difficulty in accessing the necessary medical information and use of jargon and/or symbols.

MRO converts these unstructured data – as found in paper or imaged medical documents, housed in document management or claims transaction systems into highly structured information through file assembly.

Key features of MRO are:

  • medical records are sorted and arranged in chronological order (with sorts also available by other fields). Raw medical data in different formats, and hand-written are further transformed into a set of electronically scanned, chronologically based, consistently indexed, and formatted records packages.
  • medical abstracts for key record types, which summarize the medical facts contained within the files
  • search and indexing tools embedded in the MRO solution allow to quickly call up facts and medical context around specific treatments or body parts; tracking algorithms enable automated identification of changes in diagnosis, medication, provider or facility
  • MRO also features collaboration tools to facilitate rapid sharing of abstracts, facts and analysis which leads to improved organizational productivity and faster and efficient decision making

MedNeutral’s MRO solution (clicking on the image below for a larger view opens the larger view in a new tab of your current window) adds value in the following ways:

Soruce : MedNeutral, medneutral.com/solution-value/

Many top institutions like LexisNexis Communities  have applied MedNeutral’s MRO solution platform to streamline the medical review process and make more accurate and informed decisions for example during the Gulf Oil spill, as an example of a scalable solution capable of processing voluminous medical records, identify factors which impact value, establishes legitimacy of claims and expedites the resolution of claims from the rash of personal injury claims during this man-made disaster.

An on-going, systematic study by Accenture (a global management consulting, technology services and outsourcing company) of insurance claims performance dating back to the 1990s, showed that insurers have difficulty accessing the information in medical records due to unstructured data and believes that investment in information technology in this area, with a shift to a structured data approach, is necessary.

It was clear from the articles I sourced that the hurdles for optimizing medical records for a meaningful use are both technological and organisational. An area for investment is in developing and promoting industry standards for medical records. But what is really important is taking a comprehensive look at the way medical information is acquired and handled, a probable progression to electronic medical records.

As hindsight, I could not find any mention of MRO from the scientific programme for the 6th International Casemix Conference 2012.

I can only assume that the topic Medical Records Optimization was planned to be included for this casemix conference as the processes of digitization, indexing, abstraction, collaboration and analysis are similarly applied to optimize medical records contents for casemix.

After knowing what MRO was all about, I decided to refresh my rusty memory about Casemix as I vaguely remembered casemix is about the difficult challenge of reducing costs while maintaining or improving quality of care and access. I also remember that Casemix was about methodologies, which categorise patients into statistically and clinically homogeneous groups based on the collection of clinical and administrative data  and the interpretation of hospital patient data related to the types of cases treated, in order to assist hospitals define their products, measure their productivity and assess quality.

Casemix data also allows support for a unique collaboration between clinicians, statisticians, accountants, managers, funders and policy makers as it provides a common language that is freely shared with a strong focus on Peer Group review.

From further reading about Casemix lead me to believe that Casemix used similar techniques by MRO in claims processing, to optimize medical records. Casemix classified patients into a manageable number of groups (patients in the same group should cost roughly the same to treat) but poor quality information meant poor quality casemix information, and thus the quality of Casemix information rests with clinician documentation, clinical coders and accuracy of information systems, that is much needed and desperate call for a structured data approach in medical records.

I shall conclude that the reference to medical records optimization for the 6th International Casemix Conference 2012 had nothing to do with MedNeutral’s trademarked Medical Records Optimization™ (MRO) product solution that was largely used by companies for claims processing, but wanted would-be speakers to speak and present on how medical records could be optimised for Casemix purposes.

References :
Casemix for Beginners, The National Casemix & Activity Based Funding Conference, 3 to 7 October, 2011 – Radisson Resort Gold Coast, Queensland, Australia, casemixconference2011.com.au/

Casemix, Canadian Institute for Health Information (CIHI), cihi.ca/

“Mastering Medical Information”, May 2009, Accenture, accenture.com/

MedNeutral, medneutral.com/solution-value/

“MedNeutral’s Medical Records Optimization for Gulf Oil Spill”, August 19, 2010, LexisNexis Communities, lexisnexis.com/

“Optimizing medical claims: A data-centric approach”, March 5, 2010, Accenture, accenture.com/us-en/blogs/accenture-blog-on-insurance/default.aspx

The Irish Casemix Programme, casemix.ie

Medical documentation in medical records of initial medical and nursing assessments

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In everyday life, you and me conduct many informal assessments. One common assessment is whether you or me is hungry and when will you or me will be able to eat next. Such assessments made each day determine many of our actions and influence our comfort and success for the remainder of the day.

Virtually every health care professional performs assessments to make professional judgments related to patients. Doctors and nurses make assessments on a patient, the patient’s family, or the patient’s community to determine medical and nursing interventions that directly or indirectly influence the health status of a patient.

Pals, the purpose of a doctor or nursing health assessment is to collect subjective data -data that rely on the feelings or opinions of the person experiencing them and which cannot be readily observed by another, and objective data – which are measurable data (also called signs) that can be seen, heard, or felt by someone other than the person experiencing them, to determine a patient’s overall level of functioning in order to make a professional clinical judgment.

Subjective data from the patient’s point of view (also referred to as symptoms) are obtained through interviews with the patient, includes:

  1. data regarding sensations or symptoms (e.g., pain, hunger)
  2. feelings (e.g., happiness, sadness)
  3. perceptions, desires, preferences, beliefs, ideas, values, and personal information that can be elicited and verified only by the patient

Objective data on the other hand, are directly observed by the examiner and those obtained by general observation and by using the four physical examination techniques: inspection, palpation, percussion, and auscultation and typically includes :

  1. physical characteristics (e.g., skin color, posture)
  2. body functions (e.g., heart rate, respiratory rate)
  3. appearance (e.g., dress and hygiene)
  4. behavior (e.g., mood, affect)
  5. measurements (e.g., blood pressure, temperature, height, weight)
  6. results of laboratory testing (e.g., platelet count, x-ray findings)

Doctors also base their initial assessments from the patient’s medical/health record as another source of objective data, which is the document that contains information about what other health care professionals (i.e., nurses, physical therapists, dietitians, social workers) observed about the patient. Doctors can also gather objective data made by observations noted by the family or significant others about the patient.

However, the purpose of a nursing health history and physical examination differs greatly from that of a medical or other type of health care examination (e.g., dietary assessment or examination for physical therapy). A nurse collects physiologic, psychological, sociocultural, developmental, and spiritual data about the patient. Thus the nurse performs holistic data collection.

In contrast, the doctor performing a medical examination focuses primarily on the patient’s physiologic development status.

As Health Information Management (HIM) / Medical Records (MR) practitioners working at a JCI accredited hospital or a hospital being accredited, you need to know about a quality standard declared by the Joint Commission International (JCI) through the Standard AOP.1.3 which states “The patient’s medical and nursing needs are identified from the initial assessments and recorded in the clinical record.” and its five (5) Measurable Elements (MEs).

The JCI quality standard AOP.1.3 is yet another medical documentation requirement as recorded in your medical records

An initial comprehensive assessment involves a collection of subjective data about a patient’s perception of his or her health of all body parts or systems, past health history, family history, and lifestyle and health practices (which includes information related to the patient’s overall function) as well as objective data gathered during a step-by-step physical examination.

In a hospital setting, the doctor is responsible for the objective data collection for an initial comprehensive assessment and usually performs a total physical examination when the patient is admitted, while the nurse typically collects the subjective data, especially those related to the patientt’s overall function.

The objective data collection by the doctor identifies the patient’s medical needs from this initial assessment, documented health history, physical exam, and other assessments performed based on the patient’s identified needs as required by the JCI Standard AOP.1.3, ME 1.

The initial assessment by a nurse is the first and most critical phase of the nursing process. If data collection is inadequate or inaccurate, incorrect nursing judgments may be made that adversely affect the remaining phases of the process: diagnosis, planning, implementation, and evaluation. Although an initial assessment process precedes the other phases in the formal nursing process, nurses are always aware that assessment is ongoing and continuous throughout all the phases of the nursing process.

The nursing care needs of the patient identified by the nurse’s holistic data collection as outlined above, thus complies with the JCI Standard AOP.1.3, ME 2 i.e the nurse’s documented assessment, the medical assessment, and other assessments performed are based on the patient’s needs.

Regardless of who collects the data, a total initial health assessment (subjective and objective data regarding functional health and body systems) is needed when the patient first enters a hospital and periodically thereafter to establish baseline data against which future health status changes can be measured and compared. Frequency of comprehensive assessments depends on the patient’s age, risk factors, health status, health promotion practices, and lifestyle

The identified medical needs and the identified nursing needs of the patient must be documented in the patient’s clinical record as required by the JCI Standard AOP.1.3, ME 3 and ME4 respectively.

To accomplish the requirements of the JCI Standard AOP.1.3 namely ME 1. ME 2, ME 3 and ME4,  a hospital must determine the following requirements incorporated within written  policies and procedures which supports consistent practice in all areas :

  1. the minimum content of the initial medical and nursing and other assessments
  2. the time frame for completion of assessments including completion of the most urgent care needs identified from integrated assessments
  3. the documentation requirements for assessments including the integration of the additional assessments by other health care practitioners, including special assessments

If the above three requirements are met, I strongly believe that a hospital complies with the JCI Standard AOP.1.3, ME 5 which states that “Policies and procedures support consistent practice in all areas”.

Although the medical and nursing assessments are primary to the initiation of care, there may be additional assessments by other health care practitioners, including special assessments and individualised assessments. This is an integration requirement of the third requirement of written  policies and procedures on initial assessments I mentioned above.

Examples are, when a physical therapist performs a musculoskeletal examination, as in the case of a stroke patient, and a dietitian who may take anthropometric measurements in addition to a subjective nutritional assessment.

These assessments must be integrated into the initial assessment and the most urgent care needs identified. This is a time frame requirement of the second requirement of written  policies and procedures on initial assessments.as I also mentioned above.

Once a patient’s medical and nursing needs are identified from the initial assessments and duly recorded in the medical record, I conclude that a hospital then complies by the JCI Standard AOP.1.3

Please take note that the JCI Standard AOP.1.3 does not include the initial medical and nursing assessments of emergency patients.

References:
Janet, W & Jane, HK 2010, Health assessment in nursing, 4th edn, Wolters Kluwer Health, Lippincott Williams & Wilkins, Philadelphia PA, USA

Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA

Sue, CD & Patricia, KL 2011, Fundamentals of Nursing: Standards & Practice, 4th edn, Delmar, Cengage Learning, NY, USA

“Distracted doctoring”

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In behalf of patients and with the concern of a drop in productivity levels in public and private hospitals, and doctors’ clincis here in Malaysia and elsewhere, I am sharing this rather amusing new phenomenon and catch-phrase I picked up this morning from some newsfeeds I am monitoring. I thought I shall share this phenomenon with you as Health Information Management (HIM) / Medical Records (MR) practitioners who in all earnestness and  probability, you must also be witnessing in your local public or private hospital in Malaysia.

“Distracted doctoring” is a new phenomenon in America (and maybe not the exception in Malaysian healthcare settings already, and a worldwide phenomena as well) has become a hot topic in medical schools, hospitals and clinics sweeping through operating rooms and clinical settings across the US when doctors and nurses are seen as not always doing work but become more focused on the screen of computers for instant access to patient data, drug information and case studies, use smartphones and other devices – and thus not the patient, even during moments of critical care, leaving patients in jeopardy of serious injury or death.The situation is increasingly acute as more and more computers are being invested in hospitals and doctors’ offices, hoping to curb medical error and as the trend of BYOD surges.

Examples of use of smartphones and other devices include a neurosurgeon making personal calls during an operation, a nurse checking airfares during surgery and when doctors and nurses text during a procedure.

It is a common scene in hospitals to see nurses, doctors and other staff members glued to their phones, computers and iPads while at work.

Perhaps it is fine and justifiable to carry devices around the hospital to do medical records if you work with EMR systems for example but not fine when staff surf the Internet or do Facebook.

Dr. Peter J. Papadakos, an anesthesiologist and director of critical care at the University of Rochester Medical Center in upstate New York who recently published an article on “electronic distraction” in Anesthesiology News, a journal shared his deep concern on this phenomenon when he said “My gut feeling is lives are in danger,” and “We’re not educating people about the problem, and it’s getting worse.”

A peer-reviewed survey of 439 medical technicians published this year in Perfusion, a journal about cardio-pulmonary bypass surgery, found that :

  1. 55 percent of technicians who monitor bypass machines acknowledged to researchers that they had talked on cellphones during heart surgery
  2. half said they had texted while in surgery
  3. about 40 percent said they believed talking on the phone during surgery to be “always an unsafe practice”
  4. about half said they believed texting during surgery to be “always an unsafe practice”

The study’s authors concluded that “Such distractions have the potential to be disastrous”.

We acknowledge that doctors are busy people, they always face interruptions from beepers and phones, and are normally expected to proficiently multitask on their jobs in order to diagnose and treat their patients in a timely and effective manner. Their multitasking tasks are made easier assisted by Information Technology.

However younger doctors tend to interact with their devices even more simply because they have grown up being constantly connected and due to the pressure caused by a mantra of modern medicine with the notion that patient care must be “data driven,” and they need to be informed by the latest, instantly accessible information.

How are some doctors reacting to this phenomenon?

Information technology “offers great potential in health care,” but doctors’ “first priority should be with the patient” declares Dr. Peter W. Carmel, president of the American Medical Association, a physicians group.

Another doctor, Dr. Abraham Verghese, also professor at the Stanford University Medical Center and a best-selling medical writer says “The computer has become a good place to get a result, communicate with other people in the interest of preventing medical error, it’s a good friend.” At the same time, he said, the wealth of data on the screen — what he frequently refers to as the “iPatient” — gets all the attention. “The iPatient is getting wonderful care across America,” Dr. Verghese said. “The real patient wonders, ‘Where is everybody?’ ”

Dr. Stephen Luczycki, an anesthesiologist and medical director in one of the surgical intensive care units at Yale-New Haven Hospital had observed the following :

  • “I’ve seen texting among people I’m supervising in the O.R.”
  • he had also seen young anesthesiologists using the operating room computer during surgery
  • “It is not, unfortunately, uncommon to see them doing any number of things with that computer beyond patient care including checking e-mail and studying or entering logs on a separate case”
  •  “Amazon, Gmail, I’ve seen all sorts of shopping, I’ve seen eBay,” he said. “You name it, I’ve seen it.”, when he uses computers in the intensive care unit and regularly sees what his colleagues were doing before him.

Dio Sumagaysay, administrative director of 24 operating rooms at Oregon Health and Science University hospitals, heard several complaints that doctors or nurses were using their phones to check or send e-mails even though they were part of a team intubating a patient before surgery, sometime in early 2010.

What did most doctors never did before this phenomenon?

One real fact I know too, is as when Dr. Stephen Luczycki  confessed that when he was in training, he was admonished to not even study a textbook in surgery, so he could focus on the rhythm and subtleties of the procedures.

What have been done to curb this phenomenon?

Mr. Sumagaysay established a policy to make operating rooms “quiet zones,” banning any activity that was not focused on patient care. He later had to reprimand a nurse he saw checking airline prices using an operating room computer during a spinal operation.

At Stanford Medical School, for example, all medical students now get iPads, which they use to read medical texts and carry with them in hospitals but are being reminded to focus on patients and patient care instead of focusing on the screens of the gadgets they are given to do their jobs. “Devices have a great capacity to reduce risk,” Dr. Charles G. Prober, senior associate dean for medical education at the school, said. “But the last thing we want to see, and what is happening in some cases now, is the computer coming between the patient and his doctor.”

To prevent distracted doctoring, some medical facilities have chosen to limit the use of electronic devices in critical settings.

How does one US lawyer view this phenomenon?

Scott J. Eldredge, is a medical malpractice lawyer in Denver. He recently represented a patient who was left partly paralysed after surgery. The neurosurgeon was distracted during the operation, using a wireless headset to talk on his cellphone.

“He was making personal calls,” Mr. Eldredge said, at least 10 of them to family and business associates, according to phone records. His client’s case was settled before a lawsuit was filed.

While doctors and nurses are blamed for “distracted doctoring”, I think you are also aware of the perils from distractions caused by computers and mobile devices which are causing productivity levels at your HIM/MR departments to take a dip, when your staff engross themselves with those gadgets while at work.

Abridged, from the original articles from AARP, “Texting During Surgery?! The Risks of ‘Distracted Doctoring’,” by Candy Sagon, published Dec. 15, 2011 and by Matt Richtel, published December 14, 2011 in The New York Times

Image credit : stlouisinjurylawblog.com

Video Explaining the Difference, CT scan and MRI

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CT Scan, MRI are two acronyms you as Health Information Management(HIM) / Medical Records(MR) practitioners have surely encountered in managing your medical records and radiology images.

I felt today I shall post on CT scan and MRI, in behalf of HIM/MR practitioners wanting to make the difference between merely executing and/or supervising basic routine functions of filing and retrieving radiology images as compared to HIM/MR practitioners who build on their knowledge base to be informed managers or able assistants.

Pals, I have had a real life experience when I had a fall, and had a MRI done on my right arm. I had no fractures but a muscle tear, which has since healed but I try not to strain my right arm.

I found a nice video (below) to share that explains all the different types of scans –  ultrasound, PET scan, CT scan and MRI. However, I queued up this video to begin at the point where it explains CT scans and MRIs, by editing the original video using a video editor (Avidemux 2.5.6), and set to play at the point where it explains MRIs  and CT scans.

The original video was made at the London Oncology Clinic, now known as Leaders in Oncology Care (www.theloc.com).

A CT – the acronym for Computerized Axial Tomography and a MRI – the acronym for Magnetic Resonance Imaging scans are different in the way they work, levels of harmful radiation, the equipment used, their cost and in the situations they are best suited for.

It’s scarring to get into a MRI scanner but usually a skilled operator is around to assure you. My experience was not so assuring as the operator did not explain things clearly. I was lucky as I was mentally prepared but imagine if it was a lay person or someone with a faint heart. I reprimanded politely to the head of the radiology department, as I think some standard operating procedures were compromised, from the viewpoint of a quality management person and certainly as an informed patient!

Maurice Slevin of MRI & CT Scan differences post

Dr. Maurice Slevin MD FRCP, Honorary Consultant Medical Oncologist Barts And The London NHS Trust
Image credit: The Times, United Kingdom

Video credit : The concept and script of this video were produced by Dr. Maurice Slevin, video production by Ted Mikulski and creation of scanners by Brenda Holder.

13 security tips as part of a data breach response plan to combat mobile device threats in the BYOD era @ your HIM/MR office

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I took you on a rendezvous about the Bring-Your-Own-Device(BYOD) phenomenon especially talking about mobile devices that can wreak havoc on a hospital in my two previous posts, The perils BYOD bring to healthcare – but before that, what is a mobile device exactly? and Patient data breaches in the BYOD and BYOC era.

Here are some pointers I picked up while fact-finding on BYOD and some 13 security tips as part of a data breach response plan to combat mobile device threats to a healthcare setting like at a hospital, and in essence as a focus of this website-blog, at your Health Information Management(HIM)/Medical Records(MR) Department backyard especially if you work with Electronic Medical Records(EMR).

  1. Get help from the IT department of your hospital to install and advice on USB locks for a low cost solution to easily plug ports and offer an additional layer of security when encryption or other software is installed on computers, laptops or other devices that may contain protected health information(PHI) or sensitive information, to prevent unauthorised data transfer (uploads or downloads) through USB ports and thumb drives
  2. Lost or stolen computing or data devices are the number one reason for healthcare data breach incidents. Consider geolocation tracking software or services for mobile devices that can immediately track, locate, or wipe the device of all data
  3. Brick the mobile device when it is lost or stolen
  4. All mobile devices including USB drives, should be encrypted if they will be used remotely and if there is a possibility sensitive data will be stored on those devices. Require the use of company owned and encrypted portable media
  5. Laptops put in “sleep” mode, as opposed to shutting them down completely, can render encryption products ineffective.
  6. Once a password is entered, a laptop is unencrypted (and unprotected) until the laptop is booted down. Simply putting the laptop into “sleep” mode does not cause the encryption protection to kick back in. A laptop that is lost or stolen while in “sleep” mode is therefore completely unprotected. Employees should be clearly advised to completely shut down their laptops before removing them from the workplace (e.g. when taking them home for the evening) and to only use the full shut down function, rather than “sleep” mode, when traveling or leaving their laptop unattended in an unsecure environment. This policy should be strictly enforced and audited.
  7. Limit the inappropriate use of personal devices (such as strong policies, training, and sanctions for noncompliance). To further reduce the risk, consider the root cause of the problem—what benefits are personal devices offering to employees that the organization’s systems are lacking. For example, if clinicians are texting PHI from personal devices because a hos­pital does not offer a similarly convenient means of communicating, then the hospital may want to consider whether it can offer a secure alternative to texting.
  8. Don’t permit access to PHI by mobile devices without strong technical safeguards: encryption, data segmentation, remote data erasure and access controls, VPN software, etc.
  9. Educate employees about the importance of safeguarding their mobile devices by not downloading applications and free software from unsanctioned online stores that may contain malware, turning off security settings, not encrypting data in transit or at rest, and not promptly reporting lost or stolen devices that may contain confidential and sensitive information
  10. As Electronic Protected Health Information (EPHI) can be accessed from a multitude of mobile devices, risks of contamination of systems by a virus introduced from a mobile device used to transmit EPHI, significantly increases.  Thus, implement an EPHI security by purchasing cyber liability insurance
  11. Ensure that the BYOD mobile devices(the user owns and is primarily in control of the device—not IT) coming offline are adequately secured and checked before disposal or donation. So once a user upgrades to a new smartphone or mobile device, the devices coming offline are almost always overlooked. Such smartphone and other devices are typically given to children to play with, donated to various charity organization or handed down to other family members—in many cases with­out confirmation that they’ve been sufficiently wiped and potentially leaving sensitive, confidential and other data intact. The result is a constant stream of devices going offline and posing significant data breach risks
  12. Have a proactive data management strategy to protect critical patient data and to allow access to patient data on an as needed basis, a stragety adopted from data protection concepts of the financial industry when for example, credit cards are now increasingly sent using tokenization technology. This technology can be adopted for the healthcare industry
  13. Transparency and End User Consent Opt-In when smartphone companies collect, share and/or store personal information; conduct a thorough technical review/risk audit of new technologies before implementation for use by patients and/or employees

I have visual!

There are many infograhics on BYOD but I like this one because it relates quite closely to all the above I have posted about.

The infographic below is a summary of findings from a study commissioned  by ESET, an IT security company founded and headquartered in Bratislava, Slovakia in 1992, which develops leading-edge security solutions against cyber threats. The study was to help companies gain a better understanding of the scale and scope of risks identified with BYOD when companies adopt a BYOD mindset, but should make sure to implement a BYOD policy, as it is no laughing matter.


Source : vbridges.com/

References:
Largely from ID Experts, idexpertscorp.com/, with cross-references from:

Elizabeth B., International Perspectives in Health Informatics, 2011, IOS Press BV, Netherlands

Karen A. W, Frances W.L and John P.G, Managing health care information systems : a practical approach for health care executives, 1st ed, 2005, Jossey-Bass, A Wiley Imprint, San Francisco, USA

Kenneth C.L and Jane P.L, Management Information Systems Managing The Digital Firm, 12 ed, Prentice Hall, 2012, New Jersey, USA

Keri E.P and Carol S.S, Managing and Using Information Systems A Strategic Approach, 2010, John Wiley & Sons, New Jersey, USA