When it comes to cybercrime, online attacks often follow seasonal trends. So as the kids head back to school, it’s safe to assume that cybercriminals have learned and developed some new ransomware tricks that will be coming to a computer near you this fall.
If you are like most healthcare organizations, you’re probably not prepared to deal with this new wave of attacks. Amongst the endless flow of sensationalistic cyberattack headlines, including NotPetya and the Erie County Medical Center, it’s easy to become numb to the threat of ransomware—choosing to believe that your organization is either too small to be a likely target or that your existing cybersecurity measures provide adequate protection. Unfortunately, this optimism has led to the peril of many healthcare providers and in turn the patients they serve.
When a ransomware disaster struck A1Care 12 years ago, CEO Percy Syddall wasn’t sure how hackers evaded his company’s defenses. All he knew was that A1Care’s computers were locked down and the perpetrators who promised to restore the system upon payment kept changing their demands. Each day the problem went unsolved further disrupted the in-home elderly care, facility placements and case management services that A1Care’s clients depended upon and threatened to destroy the business Syddall had worked so hard to build.
The Rise of Ransomware
The biggest cybersecurity concern used to be hackers invading healthcare systems to steal sensitive patient data and then selling it to the highest bidder. But today, one of the easiest assaults on a computer system is ransomware—a debilitating attack through which an anonymous criminal encrypts your files and then forces you to pay them whatever amount they request in order to regain access to your system—and all the important files it may contain.
SonicWall recently reported there have been 181.5 million ransomware attacks during the first six months of 2018, which marks a 229 percent increase over this same time frame in 2017. Encrypted threats are up 275 percent over last year.
Why has ransomware become the primary cyber threat out there? Most experts point to four primary factors:
Finding a buyer: The key to any successful transaction is finding a buyer that is willing to pay to acquire whatever it is that you are selling. When it comes to selling data on the dark web, searching for a buyer is tricky and comes with many risks. Selling something directly to the person you stole it from improves the odds of getting paid quickly and quietly.
The US government: In 2017, Shadow Brokers compromised government security defenses and delivered to the world the tools the NSA had been using to break into computers of its adversaries. Created at a huge expense to American taxpayers, those cyberweapons have now been picked up by hackers from North Korea to Russia and are being used against businesses and civilians. The WannaCry attack was born from these tools, as was the Petya attack which shut down millions of computers across the globe with demands for payments in order to restore access.
Cryptocurrency: In the old days, collecting a ransom involved suitcases full of cash (containing bills that could be marked) or wire transfers (which could be tracked). The cash then had to be laundered, which meant only large criminal organizations typically had the necessary resources. Today, anyone can sign up for a cryptocurrency wallet in a matter of minutes—some criminals even provide their victims with simple to follow instructions. With cryptocurrency, neither the wallet nor the resulting transactions can be easily connected to any real-world identities.
Ransomware-as-a-Service: Once upon a time, cybercriminals had to develop their own malware, which required coding skills and at least some knowledge of operating systems, networking and hardware. Now, easy-to-use “ransomware as a service” can be purchased cheaply on the darknet. Some vendors even offer customer support for buyers of their malware. And would-be hackers who want customized ransomware can hire black-hat coders for its development.
Healthcare is a favorite target for hackers
Smaller healthcare organizations are an easy target for hackers because most don’t have adequate financial or technical resources to defend themselves against the onslaught attacks. According to Cryptonite, healthcare organizations have reported an 89 percent year-over-year increase in ransomware attacks.
No healthcare provider wants to be a victim of an ransomware attack, but cybersecurity is a complex problem that requires multiple layers of defenses. Many owners of healthcare organizations feel they can’t afford to keep their practice safe because it typically requires deploying sophisticated endpoint technologies such as antivirus, anti-malware software and firewalls to keep intruders out and then hiring resources to keep up with frequent software, data backups and equipment security updates, as well as providing security training for staff.
Industry experts estimate that an organization with 50 employees may have to spend upward of $50,000 to have the best possible protection against cyberthreats and then thousands of dollars each year to keep everything up to date. But even when organizations make this investment in security, they might still have a breach.
Minding the security gap
Hackers are becoming extremely resourceful and have found ways to circumvent even the most advanced antivirus and anti-ransomware solutions. These solutions cannot protect against Fully UnDetectable (FUD) threats that were conceived by cyber criminals to directly evade existing security layers and harm data.
Recent Tenable research reveals, “cybercriminals have a median seven-day window of opportunity during which they can exploit a vulnerability to attack their victims.” Ponemon’s 2017 State of Endpoint Security Risk Report suggests that 69 percent of organizations don’t believe their antivirus can stop the threats they’re now seeing. Even FireEye reports “… in 100 percent of the breaches to which [they] responded … firewalls and antivirus protections were up to date.”
Antivirus software monitors for the signatures of known threats, so it can’t deal in real-time with all of the fresh attacks constantly evolving in dark web incubators. Other behavior-based security approaches use machine learning to identify threats. For example, if an email attachment tries to access a large number of files quickly or an unexpected file starts encrypting files, a behavior-based approach tries to shut it down. Today’s attackers simply avoid detection by changing the predictable characteristics of ransomware—slowing down or randomizing encryption or lying dormant for a period of time before executing the attack.
Over the past few decades, healthcare information systems has been occupying an increasingly vital role in clinical and patient care and hospital operations across the globe. Their essential role includes capturing, storing, managing, or transmitting patient data and information related to the activities of healthcare organizations. The market for healthcare information systems is on the path of rapid evolution, essentially riding on the back of rising adoption of modern healthcare IT technologies.
Various systems and the underlying technologies have gained traction in the health sector with end users aiming to leverage their potential to transform patient care and healthcare practices world over. The ambit of healthcare information systems spans wide and the broad elements comprise operational systems, administrative systems, task-based systems, and financial systems. Some of the key applications of the systems include hospital information systems, pharmacy information systems, revenue cycle management, and medical imaging information system.
Trends Underpinning Lucrativeness of Healthcare Information Systems
Several factors drive the demand and influence the uptake of healthcare information systems across the globe.
Marked Impact on Effectiveness of Healthcare
According to Transparency Market Research, the global market for healthcare information systems is massive and it was worth $227,021.4 Mn in 2017. The market is projected to rise at an impressive CAGR of 9.6 percent from 2018 to 2026.
The application of healthcare information systems assist healthcare providers in improving the quality of patient care and streamline healthcare processes. For instance, the systems may be useful to better medication management, reduce medical errors, optimize healthcare costs, and increase the accuracy of diagnosis. In several developing and developed countries, various hospital information systems have witnessed widespread adoption in the health sector. A few of the key elements of the system are electronic health records (EHRs), patient engagement solutions, pharmacy information systems, and patient engagement solutions.
Robust health information exchange services are becoming crucial to reap the benefits of healthcare information systems. This helps in expanding the access of medical records among doctors and medical technicians and is supported by strategic moves by companies. SacValley MedShare, a nonprofit health information exchange (HIE) based in Northern California, announced in June 2018 that it is merging with another HIE, Connect Healthcare. The combined entity will provide health information exchange services to clinics and hospitals giving them secure access to the medical records of more than 2.6 million patients.
Technological Advancements open Exciting Paradigms
The healthcare information systems is reaping tall benefits from the wave of technological advancement. In recent years, the swift pace of digitization of healthcare data has created new paradigms in remote patient care. Furthermore, the application of wearable technologies is positively influencing the demand for healthcare information system. In this regard, the growing application of disruptive technologies such as artificial intelligence (AI) has helped in reducing the burden of lifestyle and chronic diseases world over. The rising deployment of robots in automating routine healthcare operations is also an encouraging development.
By Shawn Yates, director of product management, Ontario Systems.
Shawn Yates
Impossible projects, crazy deadlines and short staffing present a bigger challenge than their own resolution: They draw focus away from important revenue cycle functions that maintain positive margins. Caring for the patient is, of course, the healthcare provider’s core mission. Healthcare’s financial operations help to achieve that mission.
Those involved in the revenue cycle process grasp the value efficiency and agent productivity can bring to an organization.
Reduced cost, greater performance, and the capacity to work through more patient accounts are the direct benefit, and those goals tie directly to financial performance and the core mission of outstanding patient care. Workflow, data analytics, reporting and performance dashboards are just a few of the tools you use to get to that point.
When working with new technology, having a resource to leverage from an outsourcing perspective can be very beneficial. Providers who outsource do so because they know their health system functions more efficiently when they can focus on what they do best.
What are the specific reasons that make outsourcing a particularly attractive investment right now? Three factors contribute:
It’s difficult to stay up-to-date on today’s technology. Whether it’s a smart phone, a smart appliance, or a smart digital assistant like Alexa, new features critical to your process come and go at a rapid pace. Leveraging technology outsourcing resources helps healthcare providers digest this information easier and implement solutions faster.
Siloed information means common, effective practices are shared less freely. Mergers, acquisitions, and other forms of consolidation make it difficult to reconcile the most effective practices that different parts of a health system use. A good managed services team focused on your technology can bring all that information together, which means more harmonious operation not only within your team, but in concert with others.
Increasing productivity is the key to financial success. Fully-leveraging new technology can be the key to managing talent, setting goals, and ultimately improving productivity, while using expert resources in a technology outsourcing capacity can help you bring in new features quicker. Together, these practices lead to faster returns on investment as providers today are faced with reduced reimbursements.
That was the subject line of the message from Lantern, a behavioral health startup whose app and coaching services I had used for a while. Lantern’s letter stated it is shuttering its business on August 1, helpfully offering to continue the coaching services for a limited period and pointing to other resources for those who relied on its services for six years since it started. News reports say Lantern is laying off 25 employees after failing to find a buyer for the company.
Firstly, I want to say this to the folks at Lantern: I’m sad we have to say goodbye. Although I had ceased to use the app a while back, I had developed a relationship with my personal behavioral coach who checked in with me regularly to see how I was doing with my meditation practice, often prodding me with a gentle nudge when I missed reporting on my sessions. I had the benefit of several conversations with my coach who was helpful, understanding and skilled at her work. Despite my short relationship with Lantern, I felt a positive impact on my well-being through regular meditation and mindfulness.
I came to know about Lantern back in December 2016 when I shared a stage as a speaker at an industry event with one of their executives. Back then, behavioral health was getting recognized as a $280 billion problem, which I wrote about after the Senate Health Committee announced the Mental Health Reform Act. Behavioral health is a complicated and expensive issue in U.S healthcare, which consulting firm McKinsey estimated affected 20 percent of the U.S population and was significantly underfunded in terms of treatment infrastructure.
In late 2016, there were more than 200 behavioral health startups, all of whom were responding to a brewing mental health crisis, and a favorable legislative and funding environment. Lantern was one of the highly visible ones, raising $17 million in series A money from marquee names, such as UPMC, Stanford University and Mayfield Ventures. The opioid epidemic and the exacerbation of related mental health issues was about to explode into public consciousness. Health insurance companies, faced with increasing costs for mental health and substance abuse, had started taking an interest in these startups. High profile partnerships were announced, such as the one between Highmark BCBS and Quartet. For a while, behavioral health seemed like a sure shot.
So what went wrong?
I’m sure the folks at Lantern and their VCs are pondering the question hard. However, back when I wrote about it, the signs of trouble were already visible. The Lantern executive I met at the time indicated that the lack of a reimbursement model for behavioral health was a huge challenge for growth. In healthcare, as we know, following the money is a prerequisite for success. The Department of Health and Human Services (HHS) had thrown $44.5 million at the problem, a drop in the ocean relative to the size of the problem.
Even for those who had access to funding, finding and recruiting trained clinicians with experience in behavioral health was a massive challenge.
Many startups, looking to stay outside the purview of regulation, tried to sidestep the FDA and go straight to employers and consumers (an expensive mistake that many failed digital health startups have learned the hard way).
Eventually, these problems had to come to a head. Lantern’s sad demise, brought about by a lack of ability to scale, and a lack of interest from the same insurance companies who were bullish on the sector two years ago, tells us that a business model with no revenue model has limited chances of success.
Is behavioral health dead then? Perhaps not. Many new telehealth companies, such as Teladoc, now offer behavioral health services. The CMS’s new rule to boost telehealth payments could be a shot in the arm that revives the fortunes of struggling behavioral health startups.
Patient satisfaction surveys are growing in popularity among healthcare organizations as the United States health system continues its transition to value-based care. A well-designed and distributed survey can help you discover hidden issues or gems in your organization’s care system. It can also provide useful insights on whether you’re meeting patient expectations.
If done right, your patient satisfaction survey can be a key player in building a satisfying and cohesive experience for patients. It can help you identify which aspects of care — facility appearance, provider approachability, cost, convenience, etc. — are most important to patients so you can plan improvements accordingly.
There’s just one catch: convincing patients to complete your surveys can be tough. You’ll need to up your game if you want to gather substantial feedback. To get the most out of your patient satisfaction surveys, follow these four tips:
Provide a Compelling “Why”
Even if your patient satisfaction survey takes only five minutes to complete, you’re still asking busy people to willingly give up their time. If you don’t want to be ignored, you need to give patients a good reason to spare five minutes.
In the communication accompanying your survey, let patients know you care about their experience at your facility and want their journey to be as frictionless as possible. Tell them their feedback plays a vital role in improving quality of care for all patients. Make it clear that you want to provide a best-in-class environment and service.
Keep Surveys Brief
If possible, it’s best to keep your surveys concise and simple. The longer and more complex a survey is, the less likely people are to participate. Also, if the survey is short and easy-to-understand, you’ll typically get better (and more clear) feedback from patients.
A top goal should be to ask patient satisfaction survey questions that elicit useful responses. This means keeping questions short and to the point. If a question is lengthy or focuses on more than one aspect of the patient experience, the patients’ answers may be confusing.
Avoid Paper Surveys
Although the healthcare industry is a bit behind on the digital revolution, patients are not. They expect the ease and convenience of completing surveys and other healthcare paperwork on their mobile devices. Thus, a paper survey will be met with disdain.
An online survey is user-friendly and much easier to manage than a paper survey. Patients can complete the survey whenever it is convenient for them, and all submitted data is housed in an organized database for easy analysis.
By Win Whitcomb, MD, chief medical officer, Remedy Partners.
Win Whitcomb
The Bundled Payments for Care Improvement (BPCI) Advanced initiative is a new advanced alternative payment model (APM) that will go live October 1, 2018. The successor to the 2013 BPCI program, BPCI Advanced is CMS’ most significant episodic payment reform proposal to date, indicating the government’s commitment to transitioning to paying for healthcare value rather than volume.
BPCI Advanced, a bundled payment model for Medicare fee-for-service beneficiaries, is a voluntary program in which acute-care hospitals and physician group practices may participate as “episode initiators.” As such, they will assume clinical and financial risk for patients during the episode. BPCI Advanced encompasses 32 bundles, or episodes, that include an inpatient hospitalization and the following 90-day period (save for three outpatient procedure bundles that include the procedure and 90-day follow-on period).
Applicants can choose one or more of the 32 bundles and then commit to participate with these bundles for the first five quarters of the program, at which time they can change their selected bundles. The bundled payment is carried out retrospectively where Part A and Part B claims are summed; if total payments are less than an episode initiator-specific target price, initiators keep the difference; if total payments exceed the target price, initiators must pay back overages. Performance on seven claims-based quality metrics impacts incentive payments. Episode initiators may go it alone or participate with a “convener,” which may provide services such as care-management technology, analytics and reporting, care-redesign expertise, access to post-acute provider networks, and financial risk sharing.
CMS recently distributed to applicants historical claims and target pricing data that contains Medicare Part A and B claims for each applicant, at the individual hospital-level, mapping to the 32 bundles and a target price for each bundle. Applicants can see total spending represented by all bundles and the total number of episodes. They can also see, in aggregate and for each bundle, major areas of spending during an episode, such as anchor hospitalization, readmissions, skilled nursing facilities, inpatient rehabilitation facilities, and spending tied to home health agency services, physician services, durable medical equipment, etc.
How to Succeed
Applicants should evaluate areas of high spending, high variation or both. Since BPCI Advanced is a pay-for-improvement program, applicants should select and prioritize bundles in which there is opportunity for improved performance over the baseline period (2014-2016).
Practices that improve care coordination will do well with BPCI Advanced. But keep in mind that BPCI Advanced episodes last for 90 days following anchor hospital discharge, so any readmissions occurring during this window will affect success. The best way to address this issue is to provide longer term follow-up with patients’ key physicians and other providers. One example of this is selecting the optimal discharge destination (e.g., to home without services, home with services, or post-acute facility) based on each patient’s profile. This can help improve the use of post-acute services, which account for substantial spending during an episode.
Ear, nose and throat (ENT) doctors handle a variety of cases and prescribe treatments based on what’s readily available. As technology continues to evolve and impacts the healthcare industry in not too subtle ways, ENT doctors will need to learn about new methods and approaches in their practice.
New innovations are paving the way towards more effective solutions to hearing loss. Sure enough, practitioners and healthcare providers are investing a great deal in technology as a means to satisfy new demands for better treatment plans. It’s only a matter of knowing which of these technologies can provide greater disruption in the field of ENT health.
With that being said, here are the most important technological trends ENT doctors will have to adopt.
The use of mobile apps
Mobile applications are becoming prevalent. This is made evident by the fact that nowadays there are apps for basically any purpose. Going beyond the field of financial services and education, there are now apps that cater towards specific medical needs.
For ENT doctors, apps are being developed to make it more efficient for practitioners to monitor, test, and adjust hearing aids for their patients. For instance, the ReSound app allows users to adjust the settings of their hearing aids using their mobile phones. The technology proves to be advantageous for older patients who want to address the deterioration of their hearing and lead a life with sound.
Popularity of cochlear implants
To address the long-term damages in the inner ear, ENT doctors rely on cochlear implants to restore hearing. Ever since they became a popular solution among hearing loss patients, cochlear implants have often been too expensive for many.
However, with recent innovations in ENT technology, these implants have become increasingly viable to patients. With that being said, the treatment is beginning to enjoy massive adoption by practitioners and health care providers. Moreover, it has become easier for patients to purchase accessories such as cochlear implant batteries from an increasing number of online stores that are selling to this market.
Effective time management
Even though medical technology has made it easier for doctors to manage their time, they still need to address long patient queues and maximize their activities to cover all cases in the waiting list. As always, time management has always been a complex problem being handled not only by practitioners, but hospitals as well.
In this sense, there is still a need to adopt better patient management systems. Luckily, there are productivity apps and workflow management software that can help doctors keep track of their patients and ensure optimum serviceability in their practice.
YourDoctors.Online provides patients direct access to the North American doctors. The company’s general physicians are available online to answer any general inquiry and experienced specialists for second opinions.
Elevator pitch:
We are like WebMD but with a personal touch. Connect with a personal doctor 24/7 to get personalized answers to your medical questions with an “opinion that matters.”
Founder story:
Nauman Jaffar
CEO Nauman Jaffar’s mother, aunt and boss were diagnosed with chronic diseases. Some survived due to on-time proper diagnosis while others were not that lucky. This motivated him to leave my corporate life and create a solution that connects global patients to world-class doctors. Our mission is to develop a social enterprise focused on preventing misdiagnosis and ensuring that excellent healthcare is a “click” away. We aspire to save one life at a time with medical “opinion that matters”.
Marketing/promotion strategy:
YourDoctors.Online is directly reaching out to consumers all across the world to connect patients with internet access to North American doctors get access to the best medical advice. We communicate through a variety of digital channels to not only stay top of mind but to gain awareness that getting the right medical advice is a few clicks away.
Market opportunity:
Our target audience and marketing focus is towards women from the ages between 20-35 and who for an online doctor service for their family.
Who are your competitors?
Because of the service YourDoctors.Online provides, we have no direct competitors. Companies, such as Best Doctors, 2nd.MD, do offer a similar service; however, instead of directly targeting companies and their employees, we directly going out to consumers. As a result, our patients are from 125 different countries.
How your company differentiates itself from the competition and what differentiates YourDoctors.Online?
With direct access to our customer, our competitive advantages is our brand value and our valued pricing for a medical second opinion. Since our market is international patient with various different affordability ranges, we provide our patients with access to doctors at affordable rates.
Business Model:
We have three different tiers of services such as 1) specialist who provide a medical second opinion for a premium price; 2) for our monthly members who get access to our auxiliary medical practitioners (i.e. psychologist, nutritionist, etc.); and 3) free access to our general physicians.
