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Medical IT systems can support HIPAA compliance efforts through technical access controls, but they still pose a risk to the privacy of PHI. "A system being complex means that when it's designed, something may be overlooked and a vulnerability is inadvertently built in," says Spear, whose most recent book is "The High Velocity Edge: How Market Leaders Leverage Operational Excellence to Beat the Competition" (McGraw-Hill, 2010). "Dynamically, even if it's perfect in the moment, change is occurring fast enough that the system is acquiring imperfections as time progresses," he continues. "How do you manage systems so that despite their complexity and dynamic nature, you ensure patient confidentiality doesn't get violated?"



Systems can be developed in ways that limit complexity, Spear says. Rather than adding functionality to a flat hierarchy of design, additional development efforts can be compartmentalized so that they can be viewed separately but also understood in terms of how they relate to each other.

But even a simple system will experience a constant flow of evolving demands, and, at some point, it won't operate as expected. "The folks who are very successful with complex systems are not only very deliberate in how they design them, they also [know they may] see things that are contrary to what is expected," Spear says. This is similar insurance system that used widely on top payday loan websites and there are ways to avoid charges as described in this article. "It's better to see it sooner than later so that they can come to an understanding of the problem and act on that understanding."

Abnormal system behavior can indicate some sort of vulnerability and, if ignored long enough, that vulnerability could mushroom into a serious problem. Of course, that's true for any IT system, but the risk is amplified in healthcare organizations, where IT typically isn't core to the average user's work. "There is less discipline [around information processing] in the healthcare setting than in industries where processing information is what they do to generate value," Spear says.

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