Were you considering using WebRTC? Here’s why you shouldn’t.

Waiting for WebRTC, in the style of Waiting for Godot

WebRTC vs. Native apps; The former just isn’t ready.
WebRTC is built on a great and ambitious concept: browser-based, Real-Time Communications (RTC) that is free for any developer to implement. Google released WebRTC as an open source project in 2011 and in the years since, it has attracted contributors and private businesses that have developed on that foundation. Yet five years later, it’s still often referred to as being “in its infancy”, and has yet to be fully supported across all major browsers. Check it out here: Continue reading “Were you considering using WebRTC? Here’s why you shouldn’t.” »

The 4 Standards for HIPAA’s Physical Safeguards

HIPAA’s definition on Physical Safeguards: “Administrative actions, and policies and procedures, to manage the selection, development, implementation, and maintenance of security measures to protect electronic protected health information and to manage the conduct of the covered entity’s workforce in relation to the protection of that information.” HHS.gov

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SecureVideo Launches First Responder, A Specialized HIPAA-Compliant Videoconferencing Solution

As the industry leader in HIPAA-compliant videoconferencing, SecureVideo is excited to introduce a groundbreaking new service offering; First Responder was designed specifically to meet the needs of EMTs, police, and other first responders as they often find themselves in the field, presented with a situation that could benefit from a consult or a second opinion. This new system makes that second opinion available at any time and from anywhere via mobile device with a 4G network.
“EMTs, police, firefighters, and the like, they’re well trained to handle any situation, but sometimes there’s reason to call for help,” said Tom Farris, Chief Clinical Officer at SecureVideo. “We’ve talked with first responders all over the country, and one thing we hear a lot is that. They wish there was a way to get advanced medical or mental health advice in the field. That’s why we developed First Responder, and we’re excited to see it in action.”
While SecureVideo’s First Responder solution is dedicated to making on demand sessions as easily accessible as possible, it can also be used to schedule upcoming meetings for any date or time.

How does it work?
Wherever the system has been implemented, First Responders are able to send direct requests through the touch of a button to specialized medical or mental health professionals. They can either select the button for a specific remote provider or click the button for a group queue with multiple providers. With this, they can also attach a note specifying any details or comments that may be helpful to the situation. Immediately thereafter the provider(s) will see the request, respond and then real-time relevant advice is available to the First Responder — all in a matter of moments.
The First Responder platform is always on, providing continuous connection between a First Responder and medical or mental health advisors. Potential subscribers can rest assured that all clients’ Protected Health Information (PHI) will be safeguarded to HIPAA Technical Standards, which are guaranteed upon signing of a contractual agreement.
Click here to learn more about First Responder from SecureVideo

About SecureVideo
SecureVideo.com was founded in 2012 by a team of behavioral health and technology experts in the San Francisco Bay Area; they recognized a unique need for a videoconference system that could be quickly implemented and adapted to the workflows of any medical environment — hospitals, networks, clinics, individuals and more; a system that would allow existing medical organizations to offer telehealth services. It was evident that technology could now support this “do-it-yourself” approach, but the workflows needed to be designed correctly and it needed to be supported as a service, not just technology. SecureVideo was formed to meet this need, to support medical professionals as they harness technology to transform healthcare. To learn more, visit http://www.securevideo.com

When NetBIOS over TCP/IP Name Resolution Stops Working

NetBIOS over TCP/IP, also known as NBT, is a bad idea whose time never should have come. We all know we shouldn’t use it, or WINS for that matter; we should just use DNS everywhere. And we also know that we shouldn’t eat a lot of bacon. But if someone has a plate of bacon ready for me at the bottom of the stairs every morning, I will eat some of that bacon, every morning. And so it is for NetBIOS: in a few cases, such as when connecting to a particular VPN, I will eat the bacon of technology and just let NetBIOS resolve the host names on the remote network.

For the last 15 years, this has generally worked well. And why not? NetBIOS is grossly inefficient–firing broadcasts of all kinds around the entire LAN (and if on a VPN, the remote network) to find out who is who and what is what–but that’s like using a tennis racket to hit a ping pong ball: you’ll hit the ball, every time.

Yesterday, NetBIOS name resolution just stopped working for me. I had put my Windows 7 workstation onto the network of a large corporate customer, and noticed I could no longer reach remote VPN machines using their NetBIOS names. That’s OK, I thought, when I get back onto my home network, all will be well. But all wasn’t well, even on my home network.

After quite a bit of googling, trial, and failure, most of it involving running various nbtstat commands on my adapters or net view commands, I found that ipconfig /all showed a working computer to have a Node Type of “Hybrid“, and my failing workstation to have a Node Type of “Peer-Peer“.

To set the Node Type to “Hybrid”, I had to edit the registry as described here, using these steps:

1) Run the registry editor and open this key: HKEY_LOCAL_MACHINE\System\CurrentControlSet\Services\Netbt\Parameters
2) Delete the DhcpNodeType value if it’s present.
3) If the NodeType value isn’t present, create it using type: DWORD.
4) Set NodeType to 8 (Hybrid).

Then I disabled and re-enabled my network adapter, and voila! I could once again use NetBIOS, both on my LAN and to reach remote hosts over VPN. Now that’s some good bacon!

Choosing a HIPAA-compliant Videoconferencing Platform Is Easy When You Know What to Look For

Telemedicine offers a host of benefits to healthcare providers and their patients alike. Providers are able to treat patients quickly and efficiently; they often achieve better health outcomes, and can offer exceptional care to individuals they might not otherwise be able to reach. Likewise, patients no longer have to miss work or endure the cost to travel, are more likely to keep follow-up appointments, and can generally better manage chronic conditions. The adoption of videoconferencing technologies seems like a win-win, and the next logical step to take in growing your medical practice, but there’s one lingering concern: ensuring HIPAA compliance.

Fortunately, it’s as easy as choosing a HIPAA-compliant videoconferencing platform (Like that offered by SecureVideo).

The right telemedicine platform can afford practitioners the unique ability to diagnose and treat remote patients without sacrificing the security of their personal health information — or, not to mention, the practitioner’s compliance with the Health Insurance Portability and Accountability Act (HIPAA). That said, it’s important to understand that not all videoconferencing solutions are created equal. It’s important to do the research, to talk with the providers under consideration, and to select one that meets all the right benchmarks.

The solution must be encrypted.

 What does that mean, an encrypted solution? In a word: protection. The process of encryption scrambles the video packets of data as they travel across the Web, so that data cannot be intercepted and understood until it reaches the video software on the recipient’s device and is then decrypted.

Why is that so important, encryption? A patient sitting in an exam room with his doctor feels secure knowing he and his health information are… secure. An encrypted videoconferencing solution promises patients the same level of protection when receiving medical care remotely.

The videoconferencing solution should leverage peer-to-peer networking.

What does that even mean? The videoconferencing solution you choose for use in your medical practice should leverage a certain type of Internet connection known as a peer-to-peer network. Networks, and connections of this type are the most secure method of transmission since they do not need to run through a server, at which point data streams are most vulnerable to attack.

Again, it’s all about protecting the patient and his health.

It is vitally important that session recording be done in a secure, and HIPAA-compliant manner.

The recording of videoconference sessions creates significant security risks, but also creates a vital history of care. SecureVideo ensures the utmost levels of HIPAA compliance in the storage of session data on the cloud — for the healthcare provider’s benefit as well as the patient’s. (It should be noted: Session data should never, ever be stored within the local files on one’s computer.)

A Business Associate Agreement should be offered.

 Under the guidelines set out by HIPAA for these purposes, the solutions provider (known as the business associate, defined as any entity that will perform activities on behalf of) and the provider must enter into a contract to ensure that all protected health information is safeguarded by all parties. Request, read, and understand the agreement offered, and don’t consider a provider who will not offer one.

Leaps in technology can be intimidating, and maybe even more so when there are privacy and security related laws to consider. But the good news is this: You don’t have to look any farther, because there’s one solution that has it all.

Contact SecureVideo today to discuss your HIPAA-compliant videoconferencing needs, and what we can do to propel your practice into the future of telemedicine

Global Barometric Variation – Annual Maps and Monthly Raw Data

Variance-Annual-Global

When I published my first post on Avoiding Migraines Resulting From Changes In Barometric Pressure in 2013, I had no idea how many fellow migraineurs would read, engage, and comment.

“Hi guys, OK so this really does work. I suffered when I lived in Virginia. Moved to Georgia, no headaches, moved back to Virginia, headaches, moved to Delaware, suffered horribly. The worst ever! Found this article, moved back to Georgia, no headaches. I’m so serious, I can live now.” – Kyle

I have been touched by the gratitude shown by many of the readers, and inspired that I have been able to help others–if not with their migraines directly, then at least with a better understanding of one apparently common migraine trigger. Many were happy to see some useful data that could help them understand the barometric pressure characteristics of places where they lived or were considering moving to. Others asked me where I got my data, some wanted to see hourly variation, and many others wanted to see global variation data.

Could u be kind & send me a list of the best worst places to live in Western Europe. I am hoping your list will identify the best place to live in UK I suspect all of the UK will be bad but I am stuck until I can retire & cant move to Spain or Malta until then…Thank u God for guiding me to this site. – Harry

For those who wanted more, this post is for you.

(The Usual Disclaimer: I’m not a doctor, and am in no way qualified to give medical advice. I organized this data for myself and for the benefit of those who believe that living in a place with less barometric variation could be good for their health, so that they could see which cities have more or less barometric variation.)

Where I Got My Data

Although the original data set I used to compile my original U.S. list does not seem to be online any longer, I was able to find a global dataset at the FTP site in the National Climactic Data Center (NCDC) public area of the National Oceanic and Atmospheric Administration (NOAA), which contains barometric pressure readings for more than 11,700 weather stations around the world. Downloading all data from 2008 through March of 2016, I constructed a database of over 322 million barometric measurements, many of them taken at intervals as short as 15 minutes.  The database size weighs in at just under 10 gigabytes. There’s so much data, in fact, that my first task was to take a sample to see if hourly or every-15-minute data would prove to be more useful than 24 hour data. If I could research global barometric variation using the daily data set, it would really save on computing resources and allow me to publish results much more quickly.

Hourly Variation

I chose 13 weather stations distributed through the world which were in larger population centers (as opposed to weather rafts or remote air force bases), and which had hourly pressure data available since 2008–there were only 476 of these to choose from, the vast majority of them in the U.S. (320) or Canada (129). I then compared the percentage of days per year that experienced my standard migraine-inducing daily variation threshold (a .20 or greater change between 24 hour measurements) with a new hourly variation threshold: a .02 or greater change between any two hourly measurements). I selected the .02 hourly threshold because, like a .20 pressure change over a 24 hour period, a .02 pressure change in an hour occurs at approximately a 20% rate throughout the data set.

Here are the data on hourly variation:

Daily-versus-Hourly

Here are those data plotted for correlation:

Daily-versus-Hourly-Correlation

Other than the outlier–Denver (which as a high altitude city can expect to have greater measurement error, greater true variation, or both)–it seems reasonable to conclude that daily barometric variation is an excellent proxy for understanding hourly barometric variation.

Global Variation Data

Using daily changes, I was able to construct both a master list and several maps showing the annual barometric pressure variation of the world cities.

Let’s show the maps first, because they reveal some rather amazing patterns regarding barometric pressure variation.

Note: If you want to see the maps in full screen mode, you can click on them to get a full screen slideshow. You can also right-click and then open each image in a new tab, and if you do this, on the new tab you can zoom the browser in to closely examine the a region of interest.

The World

Variance-Annual-Global

First, you can see that there’s not much red (more than 50% of days reaching the .20 threshold variation is quite rare on this planet), so for the most part, blue means very few days of high pressure variation, green means more days of high variation, and yellowish colors mean a lot of days of high barometric pressure variation. For my migraine patterns, I would live anywhere that is colored dark blue without a moment’s hesitation, and I would not want to live anywhere green and certainly not anywhere yellow. (Anecdotally, my migraines have been at their worst the times I have lived on the U.S. East Coast, and at their best when I have lived in California).

Second, you can see that these variations are almost perfectly related to latitude, with practically zero variation in the tropics, and latitudes in the Northern Hemisphere generally showing lower variation than counterpart latitudes in the Southern Hemisphere. There are some interesting exceptions:

  • Coastal California, Portugal, Italy, and the Balkans seem to have considerably smaller pressure variation than would be expected from their latitudes. So these are likely better than expected places to live for migraineurs.
  • The United States East Coast has high variation relative to its latitude.
  • The United States Mountain Time Zone has very high variation relative to its latitude.

Next, you can review eight detailed zoom-ins on the global map.

North America

The further south, the better, except for California, which is all blue. It is worth pointing out that there is a material difference between Crescent City, in extreme Northern California (12% of days annually cross the .20 threshold) and San Diego (1% of days), just not enough to change the colors on this particular map. (Interested viewers can download the raw data spreadsheet at the bottom of this document for more details.) Also of note, some of the highest barometric variation in the world occurs in North Dakota for some reason.

Variance-Annual-North-America

Eurasia and North Africa

Europe and North Africa follow latitudes pretty closely, with the biggest surprises in the United Kingdom and Japan. Ireland has much higher barometric variation than expected for its latitude. The East Coast of Central Japan has shockingly high variation given that it’s on the same latitude as places with almost no barometric variation like Tel Aviv, Lisbon, and Islamabad. Norway also seems to be a bit worse than comparable latitudes in Sweden or Finland.

Variance-Annual-Eurasia-North-Africa

Africa and South Asia

Ah, tropical living! Except for the unexpected swath of pressure variation in Coastal South Africa, living anywhere on this map would have you pretty safe from pressure-induced migraines.

Variance-Annual-Africa

Oceania

Oceania follows latitude predictions as expected. Sydney has low variation, Melbourne is moderate, and New Zealand can get extreme on its wild southern end. I have no idea why Sydney and Melbourne don’t show up on this mapping software, where instead we see Newcastle and Traralgon.

Variance-Annual-Oceana

South America

Very high and narrow mountain ranges such as the Sierras and Andes seem to throw off latitude correlation. In South America, there is a line of exceptionally high variation on the Eastern edge of the Andes. This is similar to the line of exceptionally low variation on the Western edge of the Sierras in North America.

Variance-Annual-South-America

Western Europe

In Western Europe, there are very few measurements available in Germany for some reason. As mentioned earlier, Ireland and Scotland have shockingly high pressure variation, presumably related to the legendary wind and rainfall in those areas. (In addition to not be a medical doctor, I’m also not a meteorologist. I’m just a guy who gets a lot of migraines when the barometric pressure changes, and I’m happy to know that I shouldn’t ever visit Ireland in January.) I don’t understand the blue dots in the area of Northern Poland and Lithuania, but maybe migraineurs there are getting a little bit of a break. Or maybe there’s some measurement error there.

Variance-Annual-Western-Europe

United States

I’ve written a lot about the United States in prior articles, so I just leave it at wondering this: why does central North Dakota have the highest barometric pressure variation on the planet? If you go about 500 miles due east or west, you get to Duluth/Superior or Missoula, where there’s still a decent amount of pressure variation, but nothing like the worst variation on Earth. Denver is also much, much worse than you would expect. Another case of being on the Eastern edge of a large mountain range? Or perhaps more measurement error?

Variance-Annual-United-States

Canada

Canada is really not a good place for migraine sufferers who are triggered by changes in barometric pressure. The best major cities in Canada seem to be Vancouver, Toronto, and Montreal, so at least that covers a reasonable percentage of the Canadian population. Flin Flon, Manitoba seems particularly bad. Yes, I just wanted to write the words “Flin Flon, Manitoba”.

Variance-Annual-Canada

 

Zero Days of .20 Variation Over 2,000 or More Measurements

For those of you who would like to visit a place that has not experienced a single day of .20+ variation since 2008, and for which we have at least 2,000 recorded pressure measurements since that time, there happen to be 245 such places on this planet. Note that many places between the tropics have certainly had zero days of .20+ variation since 2008, but do not appear on this map because we don’t have 2,000 measurements for those places. This would likely be the case with much of Africa. To get a good look at this map, you can right-click on the map and select “Open image in new tab”, and then zoom in on the image.

Zero-Variance-Worldwide

 

The Raw Data

Saving the best for last, perhaps, feel free to download this Global-Barometric-Pressure-Threshold-Variation Excel spreadsheet. It contains the threshold variation percentage for every weather station with at least 50 daily change measurements since 2008, and the spreadsheet tabs provide both annual and month-by-month data. The spreadsheet is 3.5 MB is size, and so might take a little while to download on slower internet connections.

So, for example, if you live in Cape Town, South Africa, you could go to the Annual tab of the spreadsheet, use Control-F to search for “CAPE TOWN”, and see that at the Cape Town International Airport (CAPE TOWN INTL) has 14% of its days throughout the year (51 days) experience a barometric pressure variation of .20 or higher. If .20 pressure variation triggers a migraine headache every time, then a migraineur who lives in Cape Town could expect at least 51 migraines per year while living there. If you want to see whether this varies by season, which it does in every place that I’ve examined, you could go to the January tab, use Control-F to search for “CAPE TOWN”, and see that only 4% of days in January (perhaps one day each January) experience threshold variation. So the summer in Cape Town, as with most places, is a time of much lower barometric pressure variation. Looking at the winter in South Africa, in July, shows that 23% of days in July (an average of 7 days each July) experience threshold variation in Cape Town, which would be problematic for a migraine sufferer with a barometric pressure variation trigger.

This spreadsheet is the best way to see the month-by-month variation for the weather station closest to where you live.

Telemedicine is revolutionizing healthcare for millions of rural Americans.

Have you considered HIPAA-compliant videoconferencing for your medical office?

More and more health systems across the country are making telehealth — specifically HIPAA-compliant videoconferencing systems available to their patients for primary care video visits; is yours among them? Perhaps it should be. But why? And how?

Why are so many American health systems embracing telehealth as a new model of care? And how will doing so affect and improve the operations of your medical office?

The benefits of implementing telehealth solutions are innumerable — for your patients, for your medical practice, and for the good of the public health in general.

Deliver a better experience that will retain and attract patients.

Patients tare — steadily and consistently, incredibly so — pleased with the care they have been able to receive via videoconferencing. Such solutions increase the availability of after-hours care; they reduce wait times, and travel times, and the associated costs therein. This high satisfaction then only leads to be a better overall experience, and a happy patient is a patient who will choose to stay with his doctor. Likewise, telehealth capability may attract new patients beyond the immediate vicinity of your office.

Reduce hospital admission rates.

Hospital readmission rates are high, too high; this is alarming not only for the health of the patient but also because of the cost. Telehealth is a welcome solution to a big problem, as its use can help reduce admission rates by enabling doctors, care managers or pharmacists to see patients over video for follow-up care and care management for chronically ill and post-surgical patients.

Cut costs through more preventative outreach.

As the health insurance industry changes, and more patients are covered under alternative or value-based reimbursement plans, medical professionals are forced to find new ways to manage the needs to their chronically ill patients. Telehealth technologies (such as those videoconferencing solutions offered by SecureVideo) better facilitate convenient ongoing monitoring for those at-risk for hospitalization, keeping patients as healthy and costs as low as possible.

Improve clinical outcomes.

Patients who are afforded the opportunity to become active participants in their own care have significantly better outcomes, and telehealth technologies do just that. Connecting patients directly with their physicians and caregivers improves the individual experience, yes, but also bolsters their levels of compliance with medication and post-discharge instructions, and ultimately leads to a healthier, happier public.

Have you considered implementing a HIPAA-compliant videoconferencing solution?

Consider it. Contact SecureVideo for more information.

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