Telehealth Accessibility Guidelines from HHS and DOJ

telehealth kiosk lets talk interactive by Olea Kiosks

Telehealth Accessibility

As we commemorate the 32nd anniversary of the Americans with Disabilities Act (ADA), the Justice Department and the Department of Health and Human Services (HHS) are partnering to publish guidance on the protections in federal nondiscrimination laws, including the ADA, Section 504 of the Rehabilitation Act of 1973, Title VI of the Civil Rights Act of 1964 and Section 1557 of the Patient Protection and Affordable Care Act, requiring that telehealth be accessible to people with disabilities and limited English proficient persons. These laws work in tandem to prohibit discrimination and protect access to health care. The guidance is available here on the Justice Department website.  The guidance is also available here on the HHS website.

“Telehealth has become an evolving and common pathway for accessing healthcare, particularly as our society becomes increasingly digitized,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “It is critical to ensure that telehealth care is accessible to all, including patients with disabilities, those with limited English proficiency and people of all races and national origins. Federal civil rights laws protect patients from discrimination regardless of whether they are receiving health care online or at the doctor’s office. The Department of Justice will vigorously enforce the ADA and other civil rights laws to ensure that health care providers offering telehealth services are doing so free from discrimination.”

“We have seen important expansions in health care technologies, such as telehealth, that provide great convenience and help for people seeking care,” said Acting Director Melanie Fontes Rainer of HHS’s Office for Civil Rights. “This guidance makes clear that there is a legal obligation to ensure that all people receive full access to needed health care and can connect to telehealth services, free of discriminatory barriers. While we celebrate the progress of the ADA, we know how important it remains to uphold the rights of people with disabilities and other protected individuals to make our country accessible and inclusive for all. That work has been a priority of this Administration from day one, and President Biden’s Executive Order on advancing equity explicitly includes people with disabilities in its call for comprehensive action.”

Technological developments and the COVID-19 public health emergency have increased the importance of providing telehealth and greatly expanded its use. Telehealth can take many forms, including communication between a patient and a health care provider via video, phone or other electronic means. While telehealth has many benefits, including making health care more available and convenient, certain populations may face discrimination or other barriers in accessing care provided via telehealth. For example:

  • A person who is blind or has limited vision may find that the web-based platform their doctor uses for telehealth appointments does not support screen reader software.
  • A person who is deaf and communicates with a sign language interpreter may find that the video conferencing program their provider uses does not allow an interpreter to join the appointment from a separate location.
  • A limited English proficient person may need instructions in a language other than English about how to set up a telehealth appointment.

The HHS Office for Civil Rights and Justice Department’s Civil Rights Division have collaborated to provide this new guidance to help health care providers better understand their nondiscrimination obligations and patients better understand their rights under federal law in this area. The guidance provides examples of actions that may be discriminatory and describes steps that providers may need to take to ensure that health care offered via telehealth is accessible. The guidance also provides a list of resources that providers and patients may wish to consult for additional information about telehealth and civil rights protections.

If you believe that you or someone else has been discriminated against because of your race, color, national origin, disability, age, sex or religion in programs or activities that HHS directly operates or to which HHS provides federal financial assistance, you may file a complaint with the HHS Office for Civil Rights at: https://www.hhs.gov/civil-rights/filing-a-complaint/index.html.

If you believe that a telehealth provider has violated your or another person’s civil rights, you may file a complaint with the Department of Justice Civil Rights Division at: https://civilrights.justice.gov/#report-a-violation.

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The VA Cerner Situation – Oracles First Test

VA Logo

VA Cerner Problems

From Business Insider

  • Oracle in June purchased Cerner, a medical-records giant, for about $28 billion.
  • The US Department of Veterans Affairs tapped Cerner in 2018 to overhaul its information systems.
  • Long-standing issues with the technology and the cost of the project just became Oracle’s problem.

Excerpt

Before 2018, the VA was identifying some of the same problems Ellison said he wanted to fix. The Department of Defense provides medical care to troops until they become veterans, at which point the VA takes over. One goal of the VA’s upgrade was to give providers at both organizations a way to see those patients’ records digitally.

But VA officials have said this goal, among others, has suffered as the Cerner rollout has dragged on. The Office of Inspector General overseeing the VA has issued more than 10 reports about several issues and more than 60 recommended fixes, a handful of which are two years old and still haven’t been implemented, frustrating lawmakers.

Crashes and slowdowns of Cerner’s technology have caused VA staffers to switch to pen and paper. Providers have struggled to learn the new system, leading the VA to implement more training. And a quirk of the Cerner record has sent physicians’ medical orders in Spokane, Washington, to an unmanned inbox, leading to delays in care.

One of the reports described a case in which a psychiatrist’s order to schedule a follow-up appointment for a patient without a home was lost in the queue. The report said the patient, who was at risk of suicide, called a crisis line four weeks later about a plan to self-harm, then was hospitalized.

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HIPAA Modernization – Open Request/Call for Input

HIPAA Compliance Kiosk

HIPAA Kiosks News

I manage a self-service and kiosk association and we are doing a feature article on HIPAA modernization. The Cassidy/Baldwin Senate modernization of HIPAA initiative is in progress. It has the support of many companies as well as major health groups. It would be ideal to get some comments from compliance officer there.

What are the ways that HIPAA and data privacy in general could and should be modernized?

It’s worth noting that the U.S. Access Board is also issuing an ANPRM for kiosks, EV charging, information transaction machines and Point-Of-Sale next month. The DOJ just announced they are releasing an NPRM for WCAG-related web accessibility guidelines in April 2023.

It appears that the odds of some sort of regulatory changes are greatly increased in the near and mid-term (so to speak).

If you can provide a written response to [email protected] that would great. If you have a compliance office willing to speak over the phone that would be ideal. It is your choice whether to be officially attributed or off the record.

Our writer is a contributing editor for Computerworld and TechCrunch.

Thanks!
Craig [email protected] 720-324-1837

This is a followup to Privacy Feature — https://kioskindustry.org/critical-privacy-considerations-for-kiosks-feature-article/

Regulatory Update June 2022 – US Access Board RuleMaking Session on Tap

KIosk Regulations

Updated Regulatory Information for Kiosks, POS and EV Charging – June 2022

The big news is that the U.S. Access Board has announced its next session which include EV Charging Stations, Kiosks and POS. Not quite sure of the difference between information transaction machines and kiosks but we will find out. For more updates and information contact [email protected]

  • It’s also very important (cannot be overstressed) that not only manufacturers but users need to comment.
  • Once it is closed for comments you cannot insert a single word. During the comment phase all comments are taken, recorded and considered.
  • For POS we think reach may be addressed as well as Audio

It is worth noting too that ANSI has taken a strong interest in EV Charging. The Kiosk Association is an Associate Partner sponsor of the ANSI Electric Vehicles Standards Panel and is signed up to participate on working group

In Brief

  • July 21 — The U.S. Access Board has released Design Recommendations for Accessible Electric Vehicle Charging Stations, a technical assistance document that reviews existing requirements and new recommendations for making electric vehicle (EV) charging stations accessible. This technical assistance will aid in the development of a national network of EV charging stations that is accessible to everyone, including people with disabilities.
  • US Access Board Session EV Charging — EV Charging Stations. According to the Agenda, the Access Board will be issuing a Notice of Proposed Rulemaking (NPRM) in September 2022 to set standards for accessible EV charging stations with the intent that the DOJ will eventually incorporate those guidelines in the current ADA Standards for Accessible Design. The rulemaking responds to the Infrastructure Investment and Jobs Act’s allocation of $7.5 billion to construct a national network of 500,000 EV charging stations nationwide.
  • US Access Board Session Transaction Machines — Fixed Self-service Transaction Machines. With the proliferation of self-service machines at public accommodations in the past few years, it is no surprise that the Access Board will be working on standards for accessible self-service kiosks, information transaction machines, and point-of-sale devices. The Agenda states that an NPRM will be issued in August 2022. It is very important for manufacturers of these machines, as well as the businesses that use them (e.g. retailers, rental car companies, lodging facilities, health care providers, banks, parking facilities, restaurants) to file comments on the Access Board’s forthcoming proposed guidelines because, once finalized, they are not likely to change in DOJ’s rulemaking process to make them enforceable standards.
  • Maryland Launches Assistive Technology Loan Program — Assistive technology is any item, piece of equipment, software program, or product system that is used to increase, maintain, or improve the functional capabilities of persons with disabilities. Assistive technology allows individuals with disabilities to carry out activities of daily living (bathing, dressing, eating, etc.), participate in the workforce, communicate, learn, and enjoy recreational activities.
  • Has The Time Come Finally for Accessibility and Digital Menus For Restaurants? — That’s why we’re asking the question: should restaurant accessibility standards include digital menus?  Article reprinted from Keyser, a major provider of  displays and digital menu boards.
  • Comments by Seyfarth — While the rulemaking process can take years, we predict the DOJ will work hard to get all of these new standards finalized before the end of the Biden Administration because a regime change will most certainly halt all regulatory activity, yet again.
  • Disability Inclusion in the Workplace Interview — interview of CraigK
  • DOJ Goes All in on ADA is a Nondelegable Duty — In the Statement of Interest, the DOJ goes all in on the ADA being a nondelegable duty. That the ADA is a nondelegable duty should not surprise readers of this blog because we previously discussed that here, and I return to the concept frequently.
  • Canada CSA Group — we submitted technology considerations for next CSA session.
  • Canada ADA groups — three groups in Canada have applied to join ADA Committee
  • EV Charging Expected Overall Regulations
    • guidance doc
    • EV charging stations will need to comply with ADA and Section 504 requirements and be accessible to and usable by individuals with disabilities, including those using wheelchairs or other assistive equipment. Key considerations include safety and ease of use. Specifically, designs for EV charging stations must ensure adequate space for exiting and entering the vehicle, unobstructed access to the EV charging stations, free movement around the EV charging stations and connection point on the vehicle, and clear paths and close proximity to any building entrances.
    • NEVI funds can be used to retrofit existing non-ADA compliant stations to ADA compliant
    • Revenue from retrofitted or new chargers (advertising?) will be deducted from funding received. The State DOT will likely have input on partnerships.
    • Title 3 will apply no doubt
    • 40% to disadvantage communities (underserved, underbanked)
    • Useful links for State DOT — For example, FHWA’s guide, Public Involvement Techniques for Transportation Decisionmaking, provides examples of public engagement best practices and illustrates how meaningful public engagement entails more than simply holding public events, but also incorporating public comments and feedback into decisionmaking. Additional suggested resources include:
    • • Public Involvement Techniques for Transportation Decisionmaking (FHWA) – Public Involvement
      Techniques – Publications – Public Involvement – Planning – FHWA (dot.gov)
      • Virtual Public Involvement (FHWA) – EDC-6: Virtual Public Involvement | Federal Highway
      Administration (dot.gov)
      • How to Engage Low-Literacy and Limited-English-Proficiency Populations in Transportation
      Decision Making (FHWA) – Low Limited – Publications – Planning – FHWA (dot.gov)
      • Every Place Counts Leadership Academy Transportation Toolkit (FHWA) – Every Place Counts
      Leadership Academy (transportation.gov)
  • From National Restaurant Association — The House Committee on Energy and Commerce is expected to mark up the revised American Data Privacy and Protection Act (ADPPA) next week, possibly by July 13. Restaurant operators will have a hard and costly time trying to comply with a number of alarming provisions included in the ADPPA as it’s now worded.
    • The Association has expressed concerns about specific areas of the bill, including:
    • Carveouts in the federal preemption – The Association is concerned that there are far too many carveouts for state-level privacy laws, consumer protection laws, and laws that govern both employee and biometric data, among others. These carveouts essentially nullify the bill’s preemption provision and would require national restaurant businesses to complying with both federal and state laws.
    • Inclusion of private right of action – The Association is concerned that the language allowing civil action in federal court would enable trial lawyers to embroil operators in unwarranted, never-ending litigation. These actions do not improve consumer protection but do often penalize the operations targeted.
    • Loyalty programs – The bill includes language intended to preserve consumer loyalty programs, but the Association feels the provision would inhibit consumers’ and restaurants’ ability to voluntarily establish loyalty relationships. These types of programs are essential to the business model of many restaurants, and the Association hopes the bill can be amended to reflect state data privacy laws that have already been shown to work.
    • Service providers and third-party requirements – Restaurants are often a first point of collection for consumer data, however they should not be held liable for potential data privacy violations committed by their downstream business partners. The Association would like to see the service provide and third-party requirements strengthened so that no consumers are left unprotected when their personal data is handled by any business, regardless of where they live.
    • Small data exemption – The bill includes a threshold for small business data exemption; however, the current definition will still place significant burdens on small business restaurants. The Association would like to see the requirements amended so that they will work for the smallest restaurant operators.
    • Covered entity definition – Under the current bill, the covered entity definition would mean that restaurants with common branding all become liable for one operator’s infractions. The Association would like to see the bill take into consideration the industry’s unique franchise structure when defining covered entities.
  • HIPAA — HHS issues penalties to 11 healthcare organizations for records access violations. The latest batch of penalties brings the total number of financial penalties imposed under the HIPAA Right of Access enforcement initiative up to 38, according to a July 15 press release from HHS.

Oracle ponders $1B cost reductions, laying off thousands

Oracle Cerner EHR

Cerner EHR News

From Becker

Oracle is considering cost cuts that could mean layoffs in August, according to tech publisher The Information.

An unnamed source with knowledge of the situation told the publication Oracle has considered eliminating thousands of jobs, primarily in the U.S. and Europe, as part of $1 billion cost reduction efforts.

The layoffs are being considered as Oracle evaluates its strategy to serve TikTok, the viral video app, as one of its cloud customers.

Oracle completed its $28.4 billion acquisition of Cerner in June and has since announced intentions of creating a unified national database of healthcare information. Oracle Cerner has 24.4 percent of the hospital market, and Oracle also provides the cloud infrastructure and customer relationship management platform for health systems across the U.S.

Oracle did not respond to a July 11 request for comment.

Healthcare Kiosks – The Role of Health Kiosks: Scoping Review

Patient Kiosk for Epic Welcome Kiosk by Olea

From Kiosk Industry

Healthcare Kiosks Abstract

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Oracle Buys Cerner — Now What?

Cerner EHR

Healthcare Kiosks & EHRs

Nice article off The Verge talks about it. For more information you can email [email protected]

In Brief

  • Cerner has been losing market share
  • Ellison promised nationwide
  • Oracle databases are one of the larger hacker targets
  • How many health projects has Oracle begun, and ended.
  • How has the POS market been going since they bought into that

Excerpt

Just after closing a $28 billion deal to acquire electronic health records company Cerner, tech giant Oracle said it thinks it can solve one of the biggest tech problems in healthcare: patient records.

The combined companies will create a national health records database that pulls in data from thousands of hospitals, said Larry Ellison, Oracle board chairman and chief technology officer, during a press briefing. Patient data would be anonymous until individuals give consent to share their information. “We’re building a system where all American citizens’ health records not only exist at the hospital level, but they also are in a unified national health records database,” Ellison said.

But, despite Ellison’s sweeping promises, Oracle will likely face an uphill battle to make the vision a reality. Health IT experts tweeted skepticism in the wake of the announcement. Experts in health technology and the federal government have spent years, if not decades, trying to make it easier for health records held at different institutions to communicate with each other.

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Kaiser Permanente Patient Check-in Kiosks Video

kaiser kiosks for patient check-in

Kaiser Permanente Patient Check-in Kiosks “On the Floor”

We noticed Olea Kiosks posted a new video of Kaiser Permanente kiosks for patient check-in and wanted to be sure and post. The savings for KP have been huge.

Meditech and Google Hooking Up

google search meditech

From HealthcareDive March 2022

Dive Brief:

  • Google is embedding its search and summarization tools within a health record maintained by EHR vendor Meditech, a major player in the hospital software space, in a move that should significantly expand the tech giant’s healthcare reach.
  • The partnership, announced Tuesday at HIMSS’ annual healthcare conference, will embed some of Google’s clinical tools from its Care Studio product suite within Meditech’s web-based Expanse EHR. The goal is to give doctors a comprehensive, longitudinal view of patient’s data within their workflows, by pulling and organizing information from different systems.
  • Google and Meditech have already exchanged some data in the new partnership, but will start work on directly integrating Google’s tools in Expanse within the next 90 days, and are targeting to have the functionality operational for some hospital clients within six to nine months, Helen Waters, Meditech Expanse EVP and COO, told Healthcare Dive at HIMSS.

Mental Health Telehealth Kiosk by Let’s Talk Interactive

telehealth kiosk lets talk interactive by Olea Kiosks

Noted on i-telehealth.com

Telehealth Kiosk For Mental Health and Students

Press release from Lets Talk Interactive Feb 2022 – for more information you can email [email protected]

Let’s Talk Interactive, a leading provider of customizable telehealth solutions, has provided more than 160 schools, colleges and education organizations across Florida and throughout the U.S. with technology that connects students with physicians, counselors and other healthcare providers.

As School-Based Health Care Awareness Month continues, Let’s Talk Interactive has developed systems that proactively identify at-risk students and link them to support services that address their needs. In some regions, a custom case management portal helps track students throughout their treatment and ensures the necessary roles–from parents, to providers and administrators–are notified throughout the program.

These support services are needed more than ever. Studies by the U.S. Department of Health and Human Services show that the COVID-19 pandemic greatly increased rates of mental health issues in children and teenagers and amplified the need for counseling and support services.

Children diagnosed with the illness were nearly 30% more likely to develop a mental health condition, increasing the need for schools to provide counseling assistance, the agency found. Another federal study found emergency room visits in 2020 for mental health rose 24 percent among children and more than 30 percent for teenagers.

“At a time when we are more focused on than ever physical and mental needs of children, Let’s Talk Interactive is building on its track record of helping schools give students the healthcare access they need,” said Arthur Cooksey, founder and CEO of Let’s Talk Interactive.

In the wake of Hurricane Michael in 2020, Let’s Talk Interactive deployed telehealth kiosks and portals in schools in six counties in Florida’s Panhandle region. Working with regional health care organizations, Let’s Talk Interactive’s technology facilitated thousands of sessions for students who needed mental, acute and emergency care.

In 2021, Let’s Talk Interactive expanded that service with four more Panhandle counties, and Orange and Broward counties, two of Florida’s largest jurisdictions and expanded their school based services to other regions of the United States.

Let’s Talk Interactive’s telehealth platform fully complies with FERPA and HIPAA and provides licensed backup support network for school counselors and nurses, including speech and occupational therapists, licensed counselors and psychiatrists. To learn more about Let’s Talk Interactive, Inc., visit https://letstalkinteractive.com/.

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