1. The Draw of the Telehealth Tablet
Kris Kelly-Campanale, Telehealth Systems Engineer, OHSU
David Trepp, President,
Telehealth Alliance of Oregon 2016 Summit
March 3rd, 2016

2. Introduction
Tablets offer great value for money and excellent portability. They are a natural choice for telehealth.
But there are some very important considerations to keep in mind when you’re planning your deployment.

3. Questions to Ask

4. Who is using it?
Which person or groups of people will have access to the tablet?
Are they staff members or members of the public?
How easy will it be to steal?

5. Some thoughts on BYOD Cheap…but is it worth it?
Lots of quality variation
Without the right infrastructure, high-risk
With the right MDM tools it can work
Separating personal from work is fundamental

6. How is it being used? Is this a “kiosk or “staff assigned” tablet
Level of staff-driven configuration
Which app(s) are required?
What apps can be disabled?
How well can you lock it down?
Will it be used for a mix of clinical and personal?
Who is provisioning the tablet?

7. Where are they using it?
In a limited-access clinical unit? Public lobby? In the field? At home?
Some place “messy”?
Bright or Dark Areas?
Loud or Quiet?

8. What is it accessing? Probably PHI 
What data is stored on the device?
Does it need A/V capabilities?
How much text entry is needed?
Does it need peripherals?
How is it accessing the the data (Cloud/Bluetooth)?

9. What if it gets stolen? Just assume it will be stolen
What data is stored on the device?
Can it be tracked?
Can it be remotely wiped/locked?

10. Other Considerations

11. A/V Quality Not all tablets are created equal Front camera quality
Speaker Loudness?
Mic pick-up patterns?
Echo
Fan noise
Evaluate/Demo tablets if possible

12. Packaging Protection Effect on audiovisual quality
Including Accessories
Asset Tracking
Assume it will be dropped...hard

13. Wireless Which Wireless Network to Use? Is the WiFi trusted?
AP Handoff
Signal Strength Variations

14. Cellular Speed differences between LTE/3G/Edge Location services
Know your geographical coverage area
Does your facility use a distributed antenna (DAS)?
Do you need real-time audio or video?

15. Platform Variations
Apps look and perform differently between OS and platform
Quality limitations imposed by some platforms
Network connectivity/performance
OS/hardware based security features

16. Common Tablet Attack Vectors
Ransomware attack point
Online banking man-in-the-browser attacks
Long connection time outs
Locally stored data
iOS background screen caching
Crypto-currency mining attacks

17. Practical Security Strategies
Start with a risk assessment
Assume devices will be lost or stolen
If an AP is not fully trusted, use cellular
Turn off Bluetooth when not needed
Turn off location services when not needed
If possible, logout when done
Vet all applications before downloading

18. Practical Security Strategies
Segregate work and personal content
Patch and update regularly
Rigorously apply the concept of “Lease Privilege”
Authenticate inbound
Inspect links before clicking and beware QR codes
Monitor file activity
Encrypt data at rest and in transit
Use NIST mobile standards

19. Why NIST Mobile Standards?
The comprehensive NIST library is free
Includes specific MDM guidance
SP : Securing Electronic Health Records on Mobile Devices
SP : Draft Guidelines on HW-Rooted Security in Mobile Devices
SP : Vetting the Security of Mobile Applications
SP : Guidelines for Managing the Security of Mobile Devices
Provides clear guidance for auditing and testing
SP (A) and SP
Used by federal regulatory agencies

20. Key NIST Mobile Device Controls*
*See NIST SP b

21. Examples

22. Staff-Assigned, Hospital Tablet
A tablet assigned to an employee of a hospital
Enforce PIN/Biometric Access
Enable GPS/Location Tracking
Limit access to app stores
Disable cloud services*

23. Staff-Owned, Personal Tablet
A hospital staff member using their personal device at work
Really reconsider if you want to do this!
Set up a robust mobile device management system
Geo-fencing rules

24. Language Interpreter Tablet
A tablet that is handed to a patient for language interpretation over video
Lock it down to the video app
Heavy duty, audiovisual-friendly case and stand
Built-in stand
GPS/Remote Wipe
Location tracking

25. Warm Patient Handoff Tablet
A tablet used by a pool of hospital staff for conducting a patient hand-off to a SNF via video
Restrict to clinical team’s needed apps
Heavy duty, audiovisual-friendly case and stand
Built-in stand
GPS/Remote Wipe
Location tracking

26. In-Home Patient Tablet
A tablet given to a patient for monitoring post-discharge vitals
Lock it down to needed apps
Make sure cellular data rate match the use-cases
Heavy duty, audiovisual-friendly case and stand
GPS/Remote Wipe
Location tracking
Check-in process

27. Questions & Comments