The implementation of electronic health record (EHR) is not a new thing in the industry. The digital wave has completely transformed the way medical records were maintaining before and now. With increased demand for efficiency and faster solutions, more and more medical practices are embracing EHR to simplify and organize their data storage process. Initially, many providers were reluctant and hesitant to use EHR. However, with Medicare and Medicaid incentive programs, providers are encouraged to adopt EHR. As a result, since the time EHR implementation began in 2009, around 73 percent of providers have registered for the EHR incentive program.
However, still, some challenges hinder EHR adoption and slow down the process for many. The initial implementation may be easy, but the user experience was not a good one for many.
Here are some of the obstacles that medical practices, healthcare professionals and others from the healthcare industry face while leveraging EHR:
Software testing and quality assurance have grown in critical importance for companies. Over the few years, it has established itself as a formidable career choice which is unlikely to stop anytime soon. Now as the name implies, quality insurance is all about maintaining “high quality” on a constant basis. And it isn’t surprising at all to see the concept making its way to the core of several industry verticals including the healthcare.
Quality monitoring is gaining momentum for purchasers, patients, and providers who strive hard to evaluate the value of health care expenditures. Over the past decade, science has evolved in regards to quality measurement despite a few challenges that might be a counterforce to the demands of cost containment. Well, the following post explores those crucial challenges that must be addressed in the Healthcare sector. But before that let’s take a bit of a detour which will eventually lead us to the answer.
Why the healthcare sector needs QA and testing
Speed and quality are one of the core essentials that tend to serve the healthcare industry more efficiently leading to a significant amount of inventions and advancements. One of the best examples showing how digitalization is becoming more capable of transforming the industry is that more and more number of people and devices are found connected to deliver meaningful interference from the data generated.
Technology is the best support system where different kinds of applications are created to deliver best services even at a distant. A sudden increase is found in the growth of healthcare products such as wearables, followed by applications especially the ones being associated with them. It may quite interest you to know that these can be termed as products featuring a big market and will continue to have a tremendous impact on the economy even in the upcoming years. Down below I would like to mention a few reasons stating why QA and testing are crucial in the healthcare industry.
#1 Big Data Testing in Healthcare: Because of being well associated with tons of information related to their patient’s health conditions, the healthcare industry is believed to be one of the most highly data-intensive sector. Several healthcare institutions and the associated segments to devise the right strategy building the right and relevant kind of products. Initially invented to derive the right interferences and the data point big data testing also helps in making certain decisions in regards to drug inventions, disease cure, and the last but not the least research and development. These decisions are some of the best and informed ones that anyone could take.
#2 Security of applications: I am sure you will agree with me when I say that healthcare websites have the most sensitive kind of the data about their patients and their health-related information. By security testing and penetration testing, we can make the websites, as well as applications, hack proof and sustainable especially in challenging a digital scenario. It is very important to conduct quality assurance and testing to ensure security to all such applications.
#3 Usability testing in healthcare: Usability testing is the most required in the health care industry. However, there are various features and the user scenarios that a pharmacist or a nurse can continue to face during their working hours. Do you think these tasks are of prime importance? Absolutely not! In fact, they can be eased with the help of automation, adding in more number of features that will help to simplify the entire process.
QA Challenges in Healthcare Apps
Healthcare industry has also started to introduce mobile platforms across the care delivery cycle, creating a voluminous medical app market. Further, we have extracted a few QA challenges concerning testing and healthcare mobile apps and how to get over them.
Challenge #1 Users and their expectations
Software usability has been a core element in the healthcare industry. Look at those EHR systems; it is very important to come up with something that not just offers accurate physical records but also aggregate physical activity recommendations with nutrition tracking. While testing a mhealth app, thinks about situations which patients may need it. During critical cases, older patients can make the most of condition management app that aids well in finding what their actual condition is and tap the emergency call button at an extreme point.
In addition to this, healthcare mobile apps have the potential to influence the stakeholders this includes patients, caregivers, care team members, administrative staff, insurers and more. The app should adequately support their workflows, so QA specialists need to get a good picture of basic user needs. Let’s say for example if the patient likes to connect his or her smartwatch to the app to monitor heart rate while exercising or if a physician would like to review his patient’s treatment plan progress remotely.
It has become clear in the last few years that when it comes to cybercrime, hackers are not fussy about which organization or sector they focus on – if there’s profit to be made, anyone is a potential target.
However, there are of course institutions which will always be of particular desirability to cybercriminals. Financial institutions, banks and retail are among the most targeted because the goal of most cyberattacks is financial gain, and organizations in these industries are the most lucrative targets for cybercriminals. The healthcare sector is also heavily targeted because of the personal data it holds. This data may be stolen and used for different purposes, including fraud. As a consequence, the focus on healthcare institutions by hackers has ramped up in recent years.
This increased attention on the health sector is due to hackers seeing it as an inexhaustible source of money. On multiple occasions, media reports have described leaks of data from medical centers, followed by a ransom demand sent to clinic management and patients.
There are a number of other ways criminals can monetize attacks on healthcare equipment and applications. These include threatening patient health by altering stored information; using stolen data to fraudulently obtain access to medical care or controlled medications; leveraging personal information on patients and their family members; and sabotaging websites and/or infrastructure on behalf of unscrupulous competitors. Attacking healthcare institutions also allows criminals to resell stolen data to third parties such as insurance companies, healthcare providers, banks, and others, who can use this valuable information for a number of purposes (such as advertising, research, or even discrimination based on pre-existing conditions).
One such specific way that criminals can carry out attacks is by exploiting advancements in health technology and equipment in recent years. We’ve seen an increasing number of medical devices such as pacemakers, drug pumps (like insulin infusion devices), implantable defibrillators, and other devices implementing wireless connectivity for doctors to control and fine-tune their work and update firmware. This makes these devices potentially incredibly dangerous for patients. A criminal could research and reverse communication protocols and exploit vulnerabilities in a simple piece of software used in those tiny devices, for example changing the heart rate controlled by pacemakers, injecting incorrect doses of drugs or even making them show the wrong data — leading doctors to the wrong conclusions and causing them to make mistakes in their treatment.
By Shane MacDougall, senior security engineer, Mosaic451
The other day I was asked what is the biggest information security threat facing any company in 2019. Is it ransomware? Some AI powered malware? Overpowering DDOS attacks? I didn’t hesitate – the answer is the same as it has been since I was first asked the question over two decades ago. The biggest threat to our infrastructure remains our users.
Social engineering, an attack where hackers extract information and access, not from traditional hacking attacks, but rather by interacting with a person in conversation, remains a devastatingly effective method of gaining unauthorized information or access to a network. It’s an attack vector that rarely fails. Unlike logical attacks, social engineering leaves no log entries to trip IDS or alert security admins. As organizations invest more dollars into security appliances and next-gen blinky boxes designed to harden their perimeter, attackers are increasingly opting to target the weakest link – the end user.
Recently, I was in Canada at the Hackfest hacker conference in Quebec, as host and organizer of the second installation of its social engineering “capture the flag” competition. The three part competition had the competitors first spend a week searching for specific pieces of information (flags) about their target company, from a list of items provided by Hackfest. The flags range from information that can be used for an onsite attack (who does your document disposal, what is the pickup schedule), those that can be used for a logical attack (type of operating system, service pack level, browser and email client information), networking information which gives the attacker information about the infrastructure (wifi info, VPN access, security devices), and finally information about the employee and the work environment, which could be used to help the attacker pose as an insider.
The second portion of the competition had the contestants hop into a sound proof booth, and were given 25 minutes to call their target company in front of an audience, and to gather as many flags as possible based on their dossier information. The third and final segment had competitors randomly draw a target, then each contestant had 30 minutes to use the audience members to search the web for flags or phone numbers to create a workable dossier. Each competitor was then put back into the booth to make another 25 minutes worth of calls in hunt of flags.
The results of this year’s contest were eye opening, but sadly reminiscent of last year’s event. Of the eight companies targeted, all gave out information that would give an attacker an advantage for a remote attack, on-site attack, or both. Specific breakdowns of results include:
75 percent visited a URL provided by their attacker
100 percent gave information about what version operating system/service pack version they were running
88 percent gave detailed information on what internet browser they were using
75 percent divulged information about Wi-Fi within their network
63 percent divulged information about secure document shredding, including their provider and the schedule for disposal
63 percent divulged detailed information about their email client
75 percent gave detailed information about the internal computer network
75 percent shared personal information about themselves and their work history
There’s no question that the forward march of medical technology has improved personal and public health, creating lasting positive change for humanity. New technology, however, sometimes comes with risks. While those risks rarely outweigh the potential advantages, fully exploring and preparing for them is an important responsibility.
New Solutions Pose New Dangers
One demonstration of this relationship occurred as we were developing medical devices meant to be used inside the human body. Using medical devices internally presents the problem of contamination from external sources, and we learned that killing bacteria isn’t enough — specifically, we discovered that the endotoxins produced by dead bacteria can also be harmful.
That particular issue, we’ve already solved. It is, however, an excellent example of how new benefits can present dangers that we hadn’t contended with before: our ability to kill bacteria presented a new problem as our technology continued to improve, and we started putting medical devices inside the body. We realized that some types of dead bacteria are still dangerous, and that our sterilization standards had to improve.
This relationship between new advancements and new risks continues today, although it takes different forms. The hot-button issue these days has more to do with data and privacy, which while not directly health related, has significant risks when breached.
Healthcare Data Innovations and Breakthroughs
Our ability to collect, process, and draw conclusions from ever larger amounts of data has been a huge boon to the medical industry.
Asset tracking is the process of using fluid, regularly updated databases to keep track of physical assets and tools at a facility. However, it’s useful in many more ways than inventory management. Scanning and mobile device technology allows an asset to be kept track of at every point in its journey, from storage to use.
This method of tracking and categorizing physical assets, as well as patients, can be very useful in preventing serious accidents caused by miscommunication. Even life-threatening mistakes, such as wrong-site surgery, can be prevented by good data management. Timing, types, and amounts of medication can also be streamlined with this process, which could for example automatically sweep a database for potential adverse reactions or conflicts before a drug is prescribed to a patient.
Giving doctors access to a digital database that covers a patient’s entire history is another advantage that advanced data technology can provide. These databases can be populated with information from several different sources, including family doctors, specialists, and even self-reported data. A doctor can have access to the notes of their peers in the medical community quickly and easily, vastly improving the care that a patient receives.
From a management point of view, new data technologies allow administrators to streamline the operations of their offices and hospitals. Understanding how to best utilize staff for a balance of efficiency quality has a direct impact on the health of patients.
Predictive analytics are another area which can be hugely beneficial to the healthcare field. Basically, it’s an automated process that does much of the work a doctor does already: look at a patient’s history, compare it with current medical knowledge, and use it to make predictions about that patient’s future needs. The difference is the scale at which it can be performed when automated and the sheer volume of up-to-date data that can be included. Doctors can’t be expected to keep up to date with every new study, but a database can be populated with that information to compare against.
On both a wide and individual scale, the applications of our improving data technology are saving lives and improving the quality of life of patients.
All this integration, however, comes with those pesky risks. Not nearly enough to warrant halting progress but enough to need heavy consideration.
Cybersecurity in Healthcare
The problem with health data is it’s often some of the most private and consequential data about human beings. That, unfortunately, makes it some of the most profitable to identity thieves, and even advertisers with few scruples. Healthcare data can be held to ransom, used for identity theft, or even insurance fraud. As DeVry University notes: “Your name, address, date of birth and Social Security number are all in one convenient location — ripe for stealing. Cybercriminals can take your private health information (PHI) and sell it for high prices. In fact, stolen medical records sell for 10 to 20 times more than stolen credit card numbers.”
Guest post by Sean Hughes, EVP managed document services, CynergisTek.
Healthcare has spent a significant amount of both human and financial capital addressing the security of their environments over the last several years – but have we forgotten a major vulnerability?
Printers and print-related devices (e.g. copiers, fax machines, scanners, etc.) continue to be a major component of our infrastructure and a big part of our clinical and business workflows, yet in most organizations, they continue to represent a gaping hole in our defenses. The advent of the EHR has not equated to the perceived reduction in print, but rather some research shows it’s responsible for an 11 percent increase in print in healthcare over the same time as the implementation of this technology. This increase in print volume brings with it an increase in the number of devices required to process the paper.
The approach most organizations have taken related to the security of these devices falls into one of two categories: segmentation of the network or reliance on manufacturers for “secure” devices. These approaches vary significantly from the approach most organizations have taken for other endpoint computing devices and leaves an organization open to the possibility of negative outcomes.
The industry has seen an increase in the computing power of these devices (e.g. internal hard drives, scan to file or application, residual data on devices, mobile printing, USB-enabled device access, etc.) and the bad guys are aware of this. More and more we see stories in the news of print devices being used as entryways for bad guys to circumvent our protections and put our data and our organizations at risk. According to an article published by BBC News in February 2017, “Hacker Briefly Hijacks Insecure Printers,” a hacker was able to access more than 150,000 printers that were briefly left accessible via the web.
The most effective way to address this threat is to treat these devices no differently than all our other data endpoints, be it a desktop, server, or any other piece of infrastructure. We need to look at these devices and ensure they meet the same security standards.
The most effective way to mitigate risks starts with knowing what the risks are. The first step should be a comprehensive printer fleet security assessment that is part of your overall security program. This can be accomplished either through your internal processes or by engaging a competent third party. Either way, you need to know what you don’t know, and you need to know it now.
The results of that assessment will drive the remediation efforts as well as define the ongoing measures our organizations should take. These steps will be directly related to the vulnerabilities identified but will most likely fall into the following categories:
Digital technology is arguably the best gifts of the 20th century as it has largely influenced the way the world works. Right from business to education and health, there is no sector that has been left untouched or uninfluenced by the digital revolution. Especially when we speak of the healthcare industry, we can see the huge impact that digital revolution has left on it and took it to the next stage of evolution. There are a number of benefits offered by digital revolution to the healthcare industry that has helped both patients and healthcare professionals. Let us know some of the best benefits offered by digital revolution:
Easy communication between doctor and patient
Communication plays a vital role in a doctor-patient relationship. However, there are various factors that affect free communication including long waiting hours, concerns about disclosing personal details in front of other patients and language proficiency/expression disorders. Most importantly the present state of mind of patients of doctors (agitated, confused, angry, annoyed or absent) can ruin entire communication. Patient portals offer an excellent environment for hassle-free and instant communication between doctor and patient. The patient does not have to physically visit the doctor and wait for his turn. He can message him from comforts of his home. Besides, he does not have the hesitation in revealing any personal details of any nature as he is not in a public place. He does not have to go through the hierarchy (receptionist, attendant, assistants, etc.) and can directly communicate with the doctor one-on-one.)
Relation between multiple healthcare specialists
Many patients suffer from multiple diseases or disorders that need services of different specialists. Needless to say, it is very important for all the specialists involved to maintain constant communication and share details with one another to offer the best support. Besides, some medications don’t go along well with one another. With the help of constant information sharing the specialists can identify the other medications; the patients are taking and design their medication schedule accordingly. It can also speed up the treatment, eliminate unnecessary administration jobs like attending phone calls and also allows the specialists to create, monitor, manage and modify the referral flow.
Security of data even in most unfavorable conditions
No matter how secured physical records of a hospital may be, there are always the possibilities of losing them during unexpected conditions like staff negligence or disaster. However, that’s not the case with Digital Records. It can be saved online and can be accessed from anywhere. Besides it also saves time as the digital records can be accessed by multiple health professionals at the same time. It is especially helpful for the patients who are being treated for multiple health disorders by different professionals located in different areas. The shareable information is secured using best and foolproof technology.
Mobile technology is impacting every element of American healthcare–from insurance and billing to documentation and caregiving, the impacts are being felt. The truly transformative element of the mobile revolution is not the technology itself, or the way it changes the look and feel of the tasks it affects. Despite complaints of the depersonalizing effect of technology, the ultimate value of mobile in the sector will be how it enhances and encourages communication.
Providers are Going Mobile
Already, flexibility and functionality have already drawn providers to mobile devices and solutions. Voice-to-text technology and similar automated solutions are in the offing to relieve the documentation burden that has dampered some amount of enthusiasm toward digitization. Bolstered by these advancements, caregivers will go from subjects of their EHRs to masters of patient encounters.
One of the huge benefits of mobility–as opposed to simply being networked on desktop computers or having a digital health records solution–is the capacity for greater native customization and app development. Native apps are like the currency of the mobile, smart device world providers are entering. Developers can deliver personal, branded interfaces that allow doctors to choose precisely how they want their dashboards to look, giving their EHRs a custom touch that has been sorely lacking throughout their implementation.
App-centric development will further reduce the friction of adoption and utilization, giving doctors a sense of empowerment and investment, rather than the bland inertia that has carried digitization thus far.
The personalization of the technology through app development will help boost adoption, and return the focus to what the technology enables, rather than how it looks or what it has replaced. Mobile technology’s strength will be in reconnecting doctors and patients, and creating bridges of data and communication across the continuum of care.
Data breaches and HIPAA violations became common, almost daily, news in 2015, exposing sensitive client information with devastating results. Understanding HIPAA compliance will be critical in 2016, especially since the Office for Civil Rights (OCR) will begin a new round of HIPAA audits.
In spite of record spending on firewalls, anti-virus software, malware detectors and the widget of the day, healthcare organizations keep getting hacked because the focus is in the wrong place. Here are three trends taking presence in 2016 that can help any organization fight the good fight against cyberattacks.
Buying Technology Alone is a Security Strategy That Does Not Work
Healthcare is under constant pressure to safeguard assets, however too many firms focus on security for HIPAA compliancy and then call it a day. Compliance is a legal necessity, but organizations expose themselves to cyberattack when use technology as a crutch. Many organizations will need to look at their operations as a critical network and seek ways to defend it.
A majority of breaches are from data that has been stolen, via record removal, virtually and physically. We see the trend in 2016 shifting from technology to people if healthcare organizations are going to defeat hackers.
Focus on the Human Element
Examine the largest data breaches of 2015. Technology did not protect the vast majority of these companies. In each case, data was breached due to hackers successfully exploiting humans.
The proliferation of mobile devices in healthcare like smartphones and tablets have also made the human element even more vulnerable because this area of security is often overlooked and is, in fact, the weakest link.
Technology is only as good as the people who use it and is merely a tool in the fight against cybercrime. Technology alone cannot fully protect an organization’s data, networks, or interests. This is a trend in 2016 and beyond that must be recognized if organization hope to safeguard patient records.
Health IT’s most pressing issues may be so prevalent that they can’t be contained to a single post, as is obvious here, the third installment in the series detailing some of the biggest IT issues. There are differing opinions as to what the most important issues are, but there are many clear and overwhelming problems for the sector. Data, security, interoperability and compliance are some of the more obvious, according to the following experts, but those are not all, as you likely know and we’ll continue to see.
Here, we continue to offer the perspective of some of healthcare’s insiders who offer their opinions on health IT’s greatest problems and where we should be spending a good deal, if not most, of our focus. If you’d like to read the first installment in the series, go here: Health IT’s Most Pressing Issues and Health IT’s Most Pressing Issues (Part 2). Also, feel free to let us know if you agree with the following, or add what you think are some of the sector’s biggest boondoggles.
The healthcare industry has undoubtedly become a bigger target for security threats and data breaches in recent years and in my opinion that can be attributed in large part to the industry’s movement to virtualization and the cloud. By adopting these agile, effective and cost-effective modern technological trends, it also widens the network’s attack surface area, and in turn, raises the potential risk for security threats.
We actually conducted some research recently that addresses evolving security challenges, including those impacting the healthcare industry, with the introduction of cloud infrastructures. The issue is highlighted by the fact that the growing popularity of cloud adoption has been identified as one of the key reasons IT and security professionals (57 percent) find securing their networks more difficult today than two years ago.
Paul Brient, CEO, PatientKeeper, Inc. No industry on Earth has computerized its operations with a goal to reduce productivity and efficiency. That would be absurd. Yet we see countless articles and complaints by physicians about the fact that computerization of their workflows has made them less productive, less efficient and potentially less effective. An EHR is supposed to “automate and streamline the clinician’s workflow.” But does it really? Unfortunately, no. At least not yet. Impediments to using hospital EHRs demand attention because physicians are by far the most expensive and limited resource in the healthcare system. Hopefully, the next few years will bring about the innovation and new approaches necessary to make EHRs truly work for physicians. Otherwise, the $36 billion and the countless hours hospitals across the country have spent implementing electronic systems will have been squandered.
Email security is one of healthcare’s top IT issues, thanks, in part, to budget constraints. Many healthcare organizations have already allocated the majority of IT dollars to improving systems that manage electronic patient records in order to meet HIPAA compliance. As such, data security may fall to the wayside, leaving sensitive customer information vulnerable to sophisticated cyber-attacks that combine social engineering and spear-phishing to penetrate organizations’ networks and steal critical data. Most of the major data breaches that have occurred over the past year have been initiated by this type of email-based threat. The only defense against this level of attack is a layered approach to security, which has evolved beyond traditional email security solutions that may have been adequate a few years ago, but are no longer a match for highly-targeted spear-phishing attacks.
Dr. Rae Hayward, HCISPP, director of education and training at (ISC)²
Dr. Rae Hayward
According to the 2015 (ISC)² Global Information Security Workforce Study, global healthcare industry professionals identified the following top security threats as the most concerning: malware (77 percent), application vulnerabilities (74 percent), configuration mistakes/oversights (70 percent), mobile devices (69 percent) and faulty network/system configuration (65 percent). Also, customer privacy violations, damage to the organization’s reputation and breach of laws and regulations were ranked equally as top priorities for healthcare IT security professionals.
So what do these professionals believe will help to resolve these issues? Healthcare respondents believe that network monitoring and intelligence (76 percent), along with improved intrusion detection and prevention technologies (73 percent) are security technologies that will provide significant improvements to the security posture of their organizations. Other research shows that having a business continuity management plan involved in remediation efforts will help to reduce the costs associated with a breach. Having a formal incident response plan in place prior to any incident decreases the average cost of the data breach. A strong security posture decreases not only incidents, but also the loss of data when a breach occurs.