By Heather Annolino, senior director healthcare practice, Ventiv.
As hospitals are working vigorously to address the health care needs of its patient population during the COVID-19 pandemic, they are unintentionally leaving themselves and their patients exposed to cybersecurity risks.
Measures implemented to protect workers and patients, including expanded use of telehealth and telemedicine, remote work and bringing new equipment such as ventilators online can leave data exposed, and institutions vulnerable to hackers and scammers. These cyberattacks can affect supply chains and the ability to leverage healthcare data from the COVID-19 pandemic for use in the future for other crises.
In March 2020, the Office for Civil Rights announced it would not enforce penalties for HIPAA noncompliance against providers leveraging telehealth platforms that may not comply with privacy regulations. This measure rapidly expanded the use of telehealth and telemedicine over the past several weeks, allowing providers to utilize videoconferencing platforms, including WebEx, Zoom and Skype.
The use of telemedicine improves patient access and assists with alleviating the additional burden on healthcare systems by limiting in-person care during the COVID-19 pandemic. If any incidents do occur, they should be entered into the facility’s health care risk management/patient safety software system. This technology is designed to help healthcare organizations see all of their data in one place, making it easier to learn from the incidents through analysis. While doing that now might be difficult, it is essential to capture this data to improve preparation for the next disaster and prevent patient harm.
Although telemedicine presents a lower risk from a risk management perspective, it is still important to provide consistent processes and protections to mitigate potential threats. During these uncertain times, telemedicine is the best option for providers to continue treating select segments of their patient population, as well as triage potential COVID-19 cases. Whether health care organizations are looking to expand (or even begin) the use of telemedicine capabilities, it is crucial to outline best practices for consent, credentialing, and security and privacy to assist with mitigating potential risks.
Here are a few strategies facilities should consider:
Security and Privacy
Under normal circumstances, healthcare facilities have difficulty bringing key equipment online securely. As facilities are currently working tirelessly to address COVID-19 patients’ needs in addition to continuing to provide care to non-COVID-19 patients, there is a potential increase of security risks as additional medical equipment and medical IoT devices integrate into the network.
By investing in and deploying cybersecurity procedures and protections, including backup and downtime procedures, healthcare facilities can reduce the risk of potential phishing and ransomware attempts. These measures should include ensuring all practitioners are using communication apps recommended by the U.S. Department of Health & Human Services Office for Civil Rights and secure telephone connections as well.
Chatbots have come of age. And they’ve come a long way from the clumsy pop-ups once deployed on websites to generate leads. Thanks to Artificial Intelligence, the latest generation of chatbots are more clever than ever and are increasingly playing a role in the global fight against COVID-19.
Chatbots on the Front Lines
You might not expect to find chatbots on the front lines of a public-health crisis, but multiple hospitals and health organizations have recognized their value at a time when all human hands are on deck. Take Hyro’s COVID-19 Virtual Assistant, for example, this free AI-powered, corona-focused chatbot answers questions, parses responses, poses follow-up queries of its own, triages symptoms and addresses patients’ concerns while sharing important information from the CDC and WHO.
The Hyro COVID-19 Virtual Assistant can be embedded on websites, call centers, and apps, allowing patients to freely interact with it via voice and text using their own natural language. In essence, this data-driven virtual assistant assumes the role of a human point of contact, relieving strain at a time when health organizations are increasingly overloaded. Hyro, a member of Microsoft’s Partner Network, has been entrusted by a number of healthcare facilities including New York’s Montefiore Hospital, the Austin Regional Clinic, and Ohio’s Fisher-Titus Medical Center. The tech startup has made the plug-and-play chatbot completely free for the purposes of combatting the outbreak.
How Chatbots Are Sparking Conversation
This isn’t the only example of a chatbot being integrated into the typical patient journey: developers such as Txtonomy and Orbita and have created similar conversational AI tools to help combat the rampant spread of misinformation related to Covid-19 and support medical professionals in screening patients and educating worried citizens. The UK government introduced a special WhatsApp chatbot for the same reasons. Could this be an insight into the future of healthcare: clinical smart-bots handling preliminary inquiries, screening and funnelling patients accordingly, introducing efficiencies in testing and treatment?
The coronavirus pandemic has turned the world upside down. It has claimed thousands of lives and affected millions of others. Now, the general masses are simply worried that they may catch the virus. This situation is unprecedented, and it has challenged our existence. Then, it resulted in a lock down, which confined everyone in their own homes. People across the globe have been dealing with the effects of lock down, both physical and psychological.
This situation stresses the need for our safety and of those around us. Since the beginning, the emphasis is on how we can protect ourselves. Doctors and medical experts have been advising people on the use of safety gear and precautions. They are urging them to stay indoors and care for themselves and their families. All of this revolves around one requirement; to avoid contracting the virus.
So, the question that arises here is, what steps to take to avert a virus? But let us not worry about it, but ponder upon the safety measures. In this article, we will elaborate on all the safety tips to help you be safe. Once you conclude this write-up, you will know what to do. So, let’s start.
The first reason for any infection is due to a lack of knowledge. Since we hear and discover so many diseases, we tend to confuse them with each other. For instance, many people who caught the coronavirus initially did not know clearly about it. Sometimes, we fall prey to disease as we think it might not affect us at all. However, the fact is, it does. And, when that happens, we end up putting everything at stake. So, it is a must to get adequate and relevant knowledge. For this purpose, you can use any digital resource of your choice.
In the past few months, telehealth services have helped many to obtain medical services and avoid exposure to COVID-19 while freeing up resources for those facing graver conditions. This is a great example of an unexpected circumstance quickening the adoption of new technology that will remain after the crisis has passed, but the rapid adoption has also overwhelmed telehealth services, illustrating the importance of network resilience.
Telehealth is just one relatively new application of technology that’s part of a constantly growing repertoire of connected tools. To provide optimal patient care, healthcare ecosystems require constant connectivity to many other bandwidth-intensive applications, such as IoT devices, systems to process patient data via electronic health records (EHR) and picture archiving systems (PACS). With experts predicting the Internet of Medical Things (IoMT) market to be worth $158.1 billion USD by 2022 (Deloitte), we can only expect this trend to grow.
With all these new advancements come new risks. Healthcare systems are comprised of multiple facilities, such as hospitals, labs and urgent care units that all have multi-point connectivity requirements. This requires higher capacity wide area networks (WAN) – often in the form of software-defined wide area networks (SD-WAN). If one of these points loses connectivity for reasons like a cyber-attack, an interoperability issue or a bad SD-WAN router update, the entire network could go offline.
To keep healthcare networks running, organizations need intelligent systems and processes to monitor every piece of equipment, prevent issues, and recover from incidents quickly. This will ensure the secure, always-on availability needed to decrease costs, meet strict regulatory requirements, and improve patient experiences.
Top challenges that can bring your healthcare network down
Three large challenges healthcare organizations face are protecting data, staying online during network consolidations, and unexpected incidents like natural disasters or physical equipment disruptions. These could all bring the primary network offline.
Cyber criminals constantly seek to breach data networks and harvest patient data. In this regard, ransomware attacks, which are primarily transmitted through spam/phishing or other manipulations of unprepared users operating in the primary data plane, cause many healthcare enterprises to shut down computer systems, including their EHR. No topic is off limits to hackers, and even in the past few months, research has revealed phrases like “corona” or “covid” have been featured in spam emails (RiskIQ).
Weather a health system is seeking to modernize its infrastructure or a merger has led to a large transformation, consolidating networks can also be a challenge, requiring the migration of a multitude of apps and hardware components that must stay online at all times and integrate with one another in a cohesive system.
Lastly, unexpected outages from physical events can bring a system offline by disrupting vulnerable points like last mile connections. In this regard, a wide range of network components, such as cable interconnects, switches, power supplies, storage arrays, or chillers could present problems. To support new technologies, network environments are only becoming more complex, which means more software stacks that are frequently updated and susceptible to exploits, bugs and cyberattacks.
Much like the formation of New Year’s Resolutions, the prediction of technology trends for the coming year has become a tradition among pundits, analysts and vendors alike. As the calendar turned to 2020, Hyland, like many, took the opportunity to look into a crystal ball to predict what the future might hold for the software industry at large, as well as many of the key vertical markets in which it operates.
For example, Hyland leadership revealed six overarching trends for enterprise technology as well as key trends to watch for health IT. At the time, none of us could have foreseen that a global pandemic was coming that would turn all of these predictions on their collective ears.
Of course, the healthcare industry has been particularly impacted by COVID-19. Provider organizations have justifiably focused their attention on responding to the new patient care and staffing needs brought about by the virus. That said, all of the health IT trends Hyland outlined at the beginning of 2020 (interoperability, artificial intelligence and cloud adoption) still have relevance in today’s unprecedented landscape. Although, admittedly, the reasons these topics are trending are for vastly different reasons than we originally anticipated.
I want to revisit these trends under the lens of COVID-19 as well as add a few more to the list in light of current circumstances.
Original insight: Secure access to patient information at any facility throughout a care continuum is an imperative for delivering a longitudinal digital record that travels with the patient. The key is to ensure tight integration between disparate IT systems, and to include unstructured data in the interoperability equation. As much as 80% of essential patient information is in an unstructured format – such as digital photos and videos, or physician notes – and not natively included in an electronic medical record (EMR) system. When removed from a clinician’s view, the patient record is incomplete.
New relevance: Health IT interoperability was important prior to COVID-19, and it’s even more critical now. Providers, patients and public health officials need all-encompassing data in a standardized format to better understand this evolving illness and develop guidelines. The effort to identify risk, control spread and manage the treatment of afflicted patients is a coordinated effort among multiple healthcare providers and external care partners. The easier information can be shared among these varied stakeholders, the better equipped we’ll be to combat the virus.
Artificial Intelligence (AI)
Original insight: Realistic applications of AI are coming into focus in healthcare, showing where the technology will help providers optimize workflows and better analyze the vast amounts of information needed to support improved decision making. Experts view AI technology as complementary and a true asset when it comes to helping physicians analyze the overwhelming amount of patient data they receive daily. Physicians can implement AI to streamline or eliminate tedious tasks, such as manual documentation and data search, or cull information to help them focus on a key area of interest.
The medical imaging space in particular provides a tremendous area for the growth of AI and machine-learning technologies. Clinicians can use them to analyze thousands of anonymized diagnostic patient images to identify and detect indicators of everything from lung cancer to liver disease. These technologies are also being used to accelerate research.
New relevance: AI is being used in a number of ways to address the challenges of COVID-19. For example, AI algorithms have been used to identify the spread of new clusters of unexplained pneumonia cases. Other AI applications are being used to spot signs of COVID-19 infections in chest X-rays and identify patients at high-risk of coronavirus complications based on their pre-existing medical conditions. Still others are scanning the molecular breakdown of the virus itself as well as those of existing drug compounds to identify medications that can potentially target the virus and shorten the span of the illness or lessen the severity of the symptoms. In all of these scenarios, AI is quickly analyzing large segments of data to accelerate research and treatment. This automation is indispensable in an environment where medical staff are stretched to their limits, and the act of saving time could save lives.
The COVID-19 crisis is accelerating the future of healthcare. In fact, I’d like to argue that the future is here today as demonstrated in digital health. Within weeks, this pandemic spread across our healthcare system, shutting down the traditional care delivery model and forcing us to adopt technology.
Supporting patients in a social distancing time did not provide many options but to turn to the advancements that already exist. We simply had to turn to the existing technology available and flip the switch to deploy our future healthcare model.
This is most evident with the rise of telehealth usage in lieu of point-of-care facilities such as doctor’s offices. Since the coronavirus outbreak telehealth has experienced a surge of 1,700%, particularly supporting mental health patients.
But what do patients need during this crisis and will they adopt technology as future healthcare models? We recently surveyed Medisafe users to better understand their concerns and needs during this outbreak. What we discovered is that patients are extremely appreciative of the ability to touch base, acknowledge this crisis and ask “how can we help?”
Noting that this is a primary concern, and with more than 7,000 patients responding, a majority of whom are very concerned about the coronavirus and its effects, we need to think about how to best reach a community in need an empathetic solution is needed more than ever.
Additionally, with the recent surge in telehealth to compensate for social distancing it is evident that are gaps in the daily connections and check-ins required from patients managing medications.
A majority of patients are in some form of social distancing and 55% of patients indicated that they are concerned that the coronavirus will interfere with their medication regimens. Enter the role of the digital companions. From a telemedicine solution, digital companions can offer additional insights as well as aiding in isolation by deploying guidance in a rapid response while offering a human touch in times of isolation.
Digital health technologies also offer support beyond a virtual “check-in” that can digitally handhold patients with their everyday needs, especially those managing chronic conditions or multiple medications. Digital companions keep patients continuously connected with condition management and care givers. For example, patients on multiple medications or managing complex doses or even taking injections require additional support at while at home to remain adherent to their treatment.
Digital health platforms are adept to support patients during this time, bridging isolation and bringing healthcare support into their home. In fact, more than 42% of our patients indicated that they have changed their traditional treatment routines by adopting telehealth. In addition to telehealth, digital companions offer features to keep patients connected.
Following the survey, we opened unlimited Medfriend capabilities which digitally connects family or friends with the patient’s medication schedules. Immediately, we saw Medfriend engagement activity triple. In fact, one user replied, “My mental health isn’t great right now, so knowing that you’ll tell my Medfriend if I haven’t taken [my medication] is great.”
Connection to care givers is also critical to digitize the care support teams. Fewer field support home visits are also creating concerns with patients, “I appreciate the help you’re giving. My doctor put me in home isolation 2.5 weeks ago for my sake, the only people I see are my caregivers but now they are not allowed to visit.”
Digital health that connects the daily interactions of patients with care support teams fill a critical gap. Clinicians can monitor their patient panels by following tracked activities and in fact scale their monitoring capabilities of one to many. Digital companions keep patients on therapy but also notify care support teams when patients behavior is at-risk. The combination of high-tech and high-touch is quite powerful to support patients managing chronic conditions.
Ultimately, humanizing your digital capabilities goes a long way. Digital health at its core operates on sophisticated data-driven AI to deliver personalized interventions at time of need. It’s within each of these interactions that the digital support becomes more and more relevant for patients establishing a digital relationship, trust and loyalty. However, during a crisis we also need to make sure to “check-in.”
We are all human on each end of this digital connection and when dealing with medical conditions alone during a crisis a human touch goes a long way, best stated by a patient: “I’m good. Just knowing that you are out there is a good feeling.”
Tech innovations are improving senior care by breaking down data and communication silos. That’s important in normal times and infinitely more so during times of crisis, when clear, timely communication and flexible access to care become crucial to the health and well-being of senior care residents, staff, and family members.
Here’s a look at how four key technology innovations are improving senior care and how the COVID-19 pandemic is highlighting strengths and shortcomings that fly under the radar during normal times.
1: Healthcare Systems that Talk to Each Other
A lot of senior living communities are excellent at delivering care but struggle with managing communications. And it’s no wonder: when you’re juggling multiple communication points for health records, medication administration, and communication (with staff, residents, and family members), it’s hard to keep everyone updated in ways that are both timely and HIPAA compliant.
That can be a pain point in the best of times; during a crisis like the COVID-19 pandemic, it can be dangerous.
High-risk residents may not be adequately isolated from social events, for example, if staff don’t see EHR updates in a timely fashion. Or a family member might miss an email about lockdown and visit a resident’s direct entrance, risking the spread of pathogens.
The good news is that technology that consolidates EHR, eMAR, and messaging into a single platform can streamline communications and eliminate the risks that result from missed messages and mixed signals. And these platforms don’t have to come with a months-long onboarding process; as part of our response to the current pandemic, we launched 280 communities onto our platform in just 10 days.
2: More Efficient Staff-to-Staff Communication
Too often, retirement community staff spend time documenting, reviewing, and tracking down messages from other shifts that they’d rather spend interacting with residents. Digital staff-to-staff communication platforms can eliminate that problem by facilitating communication.
For example, mobile apps can show highlights from a previous shift, including anything unusual or that requires attention. And because such apps are HIPAA-compliant and accessible from mobile devices, staff members can view key information before starting a shift, meaning they can hit the ground running each day – particularly important during crises, when policies and procedures might change from shift to shift.
Another key benefit of digital communication platforms is that they help ensure staff are accessible in case of an emergency, which can help keep everyone in a community healthy and safe. And because this tech makes it possible for messages to be conveyed fast, from anywhere, it helps reduce the total amount of time workers spend on communications and therefore maintain work-life balance.
By Carl Kunkleman, senior vice president and co-founder, ClearDATA.
Working in the world of healthcare security and compliance, I find one of the biggest dangers organizations face is having a false sense of security that their PHI is adequately protected. I’ve done hundreds of security risk assessments, and I have yet to find one single organization that did not have a security gap they were unaware they had in one or more of their administrative, technical or physical safeguards.
Add to this, the complicated current state of healthcare battling COVID-19, and we are likely to see administrative systems that have gaps in off-boarding or off-boarding employees, technical infrastructures that didn’t have time or resources for patch management, and physical scenarios in makeshift triage units with compromised physical safeguards that simply cannot be addressed in the current haste to stop the spread of the virus.
Sadly, this sense of chaos creates the ideal conditions for the hackers of the world looking to infiltrate via phishing, malware and ransomware and more. Once this spread is arrested and we all get a moment to catch our breath and assess business practices, a good move would be to conduct a security risk assessment known as an SRA. Your internal teams and resources are stressed, overworked and possibly burned out and an SRA can identify security gaps that will inevitably arise and present an actionable plan to remediate. This will help reduce risks while protecting your organization’s finances and reputation while we all find out what “getting back to normal” will mean.
Right now, we are all doing everything we can. And the Department of Health and Human Services recognized that with their decision last week to waive penalties for providers that are serving patients through everyday communications technologies during the COVID-19 public health emergency. A security risk assessment this summer will help you put the compliance health of your organization back in order. In addition to the HIPAA requirement that you have an SRA on file annually, it helps unite your team in a strategic path forward by articulating what your highest and lowest risks are, before a hacker uncovers them.
Because an SRA covers administrative, technical and security safeguards, your entire organization will benefit from the process. I continue to find organizations who think their PHI is protected because they have password protected their computers and mobile devices. Our penetration testing has revealed that passwords are relatively easy to defeat. We continue to find gaps in encryption, patch management and even with PHI inventories. If you don’t know where all of your PHI resides, how can you protect it?
Healthcare interoperability and enhanced information sharing continued to improve healthcare quality, safety and cost for U.S. patients and providers, according to the Surescripts 2019 National Progress Report. The nationwide health information network processed 19.15 billion secure transactions in 2019, while connecting 1.78 million healthcare professionals and organizations with actionable patient data for 95% of the U.S. population.
“With the COVID-19 pandemic impacting patients and providers across the globe, a trusted nationwide health information network has never been more critical,” said Tom Skelton, chief executive officer of Surescripts. “In 2019, doctors, nurses, pharmacists and others across the Surescripts Network Alliance made remarkable progress transforming interactions with patients and driving significant improvements in care quality, safety and costs.”
In 2019, healthcare professionals saw the benefits of leveraging actionable patient information to enhance the prescribing process with greater automation, improved workflows, and increased price transparency. For example:
In 2019, prescriber enablement for e-prescribing reached 79%, with 1.79 billion e-prescriptions filled, bringing the rate of e-prescribing to 80% of all prescriptions.
The number of e-prescriptions filled for controlled substances reached 134.2 million, representing 38% of controlled substance prescriptions—up 12% from the year prior, with 49% of prescribers enabled for the technology.
The volume of real-time benefit checks at the point of care increased by 336% with more than 250,000 prescribers using the service (a 233% increase).
Electronic prior authorizations increased by 132%, driven by a 58% increase in provider adoption of the tool.
Further, clinicians accessed actionable patient insights to obtain a more complete picture of their patients’ care histories and make more informed care decisions. For example:
Surescripts delivered 2.18 billion medication histories, a 19% increase, while use of Medication History for Populations increased nearly 200%.
Record Locator & Exchange delivered 333.8 million links to clinical document locations and 143.2 million documents listing where patients had previously received care. Nearly 136,000 clinicians used the service—a 28% increase in 2019.
In 2019, more than 648,000 individuals and organizations sent 37.7 million Clinical Direct Messages (a nearly 20% increase from 2018).
In the midst of this significant progress, Surescripts maintained network-wide uptime of approximately 99.999%, maintained HITRUST CSF Certified status for privacy, security and risk management practices, improved the networkwide Quality Index Score for e-prescription accuracy by 10%, and helped migrate most of the network to the National Council for Prescription Drug Programs’ (NCPDP) new e-prescribing standard (SCRIPT Standard Version 2017071).
Current Health announced that it has launched a collaboration with Mayo Clinic to develop remote monitoring solutions that accelerate the identification of COVID-19-positive patients and predict symptom and disease severity in patients, healthcare workers and other at-risk individuals in critical service sectors.
Using digital biomarkers collected by Current Health’s FDA-cleared remote monitoring sensors and platform, experts from Mayo Clinic and Current Health will also be able to expedite identification and assessment of treatment efficacy and improve care for patients with or at risk of COVID-19 infection. Through this collaboration, Current Health and Mayo Clinic aim to improve patient outcomes while preserving and optimizing health system capacity worldwide.
Today, more than 40 hospital systems around the globe use Current Health’s remote patient monitoring platform to monitor and manage patient health. These systems are now increasingly using Current Health to monitor and manage patients infected with COVID-19 at home and in the hospital. The next stage is to use digital biomarkers collected by the Current Health solutions, such as temperature, heart rate, oxygen saturation, activity and posture, to develop AI-based algorithms that can detect and predict symptom and disease severity to enable proactive treatment.
This collaboration will leverage Current Health’s existing patient database – which already includes anonymized vital sign data and raw physiological sensor data from hundreds of patients infected with COVID-19 and thousands of uninfected patients – as well as algorithms developed by Mayo Clinic, which will be used to provide individualized care to patients with complex and critical medical conditions. By working together, Current Health and Mayo Clinic hope to scale data analytics, add to Mayo Clinic’s major advancements in accelerating COVID-19 detection and diagnosis, and further efforts to understand and treat this disease.
“Our collective ability to save lives hinges on our ability to understand this virus quickly. COVID-19 has presented in many ways across different people, which has made it very challenging to understand the virus and how it develops,” said Chris McCann, CEO and Co-Founder, Current Health. “By combining our platform with the deep medical and scientific expertise that exists at Mayo Clinic, we seek to explore both known and novel biomarkers, as well as how they manifest in entirely diverse populations. This will be critical to determining how we define, and enable effective treatment of, this disease.”
“Combatting the COVID-19 pandemic is our number one priority,” said Jordan D. Miller, Ph.D., who directs the Center for Surgical Excellence and leads the investigative team at Mayo Clinic.
“Real-world, continuous data – from patients infected and not infected with the disease – is essential to understanding and predicting how the disease presents and evolves,” says Abinash Virk, M.D., an infectious disease expert at Mayo Clinic. “If we are successful in accomplishing our goals, we believe we will improve how patients with COVID-19 are identified, monitored, managed, and ultimately help with their recovery.”
Mayo Clinic will also become an investor in Current Health as part of this collaboration.