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.
By Guljeet Nagpaul, chief product officer, ACCELQ.
COVID-19 has taken a heavy toll on the U.S. and the world.
Cases and deaths continue to rise as major global economies slide into recession – or worse.
One rare, but burgeoning area of positive growth in the pandemic is telehealth. Medical services and data shares electronically has stood tall during the current health crisis.
According to data from Mordor Intelligence, the global telehealth market will grow to an estimated value of $66 billion by 2021.
Telehealth is particularly growing in data-intensive healthcare industry sectors like record-keeping, telehealth sessions and virtual, video-based doctor appointments, and the surging e-prescription sector, where physicians are increasingly able to issue prescriptions via a mobile app.
The healthcare industry is also experiencing a rise in digital epidemiology tools, chatbot systems, EHR guidance tools and rapid-response COVID-19 testing kits, among other digital-based solutions.
These tools are increasingly needed by health care practitioners to stem the COVID-19 tide – and any delays getting them into health professionals hands is a delay that coronavirus caretakers and patients can’t afford to take.
A Need for Testing and Quality Assurance
Still, even at a time of pandemic, those delays are only all too real – and the problem often lies in the archaic structure of the health care sector.
Case in point. While the coronavirus crisis has driven the need for new digital tools that have fueled a health care system transformation, the bureaucratic rigidity the health care still exists. Even as digital tools recast the entire health industry model, old problems remain, especially in the centralized and technologically inefficient modes of data management.
That’s where good data software testing and quality assurance come into play, in the form of test automation. As automation becomes the software development standard for revenue-minded companies, regular testing is required to make sure productivity and security activities are above board, and is critical in getting the digital healthcare products and services out the door and into hospitals and care centers as quickly as possible.
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.
By Nadia de la Houssaye, co-leader healthcare litigation team and head of the healthcare industry telemedicine team, Jones Walker LLP.
At its most fundamental, telehealth (or telemedicine) is nothing new. What is new is the confluence of technology development and the rapidly escalating demands being placed on healthcare providers in the face of the novel coronavirus (COVID-19) — and regulators’ willingness to bend, loosen, or change rules that previously slowed the expansion of telehealth services.
Taken together, these three factors have created an opportunity to demonstrate the value of telehealth to providers, the public, and regulators, and to cement telehealth’s place in the delivery of healthcare services.
In particular, the US Centers for Medicare and Medicaid Services (CMS) has taken an unprecedented position in its effort to utilize telehealth as one of the country’s greatest weapons to not only flatten the new-infection curve, but to also address return-to-work screening needs, including antibody testing. Americans desperately need to return to work and CMS’ encouraged use and expanded coverage for COVID-19 diagnostic testing, at no cost to the insured, will hopefully aid in expediting safe return-to-work policies.
The bottom line? CMS is granting providers a tremendous amount of leeway and it is imperative that we take advantage of this opportunity to change the face of telehealth post-COVID-19.
Since early March 2020, CMS and the Federal Trade Commission (FTC), Drug Enforcement Agency (DEA), Food and Drug Administration (FDA), Department of Health and Human Services-Office for Civil Rights (HHS-OCR), Substance Abuse and Mental Health Services Administration (SAMHSA), and numerous other federal and state agencies have issued a steady flow of guidance easing previous restrictions that constrained the use of telehealth technology. Taking a step further, many have also announced programs and procured funding to better support the use of telehealth to provide essential care to communities, families, and individuals.
As states and cities began announcing shelter-in-place requirements and guidelines, on Mar. 16, Mar. 17, and Mar. 20, 2020, HHS-OCR likewise began issuing bulletins, notifications, and FAQs announcing the decision by HHS Secretary Alex Azar to waive certain HIPAA and HITECH Act non-compliance sanctions and penalties against covered entities and providers using, among other options, telehealth and non-public facing technologies for remote communications (including good-faith use of video applications such as Zoom, Skype, and FaceTime).
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.”
As the coronavirus outbreak limits individual movement across the country, organizations are turning to remote solutions to stay operational.
As a result, demand for telehealth has skyrocketed — prompting health insurance payers, who haven’t always covered telehealth services, to reconsider coverage.
In April, the Centers for Medicare and Medicaid Services (CMS) made one of the most significant changes to Medicare/Medicaid coverage of the past few years. It announced it would expand coverage to more than 80 different telehealth services. Now, some insurers in the private sector are beginning to follow suit.
Here is how the pandemic is changing attitudes toward telehealth — and also the potential long-term impacts of coronavirus and telehealth service expansion.
Medicaid/Medicare and Telehealth Coverage Expansion
Many patients, wanting to reduce their chance of contracting or spreading COVID-19, are electing to avoid doctor’s offices. For some people — like the immuno-compromised and elderly — it’s no longer safe to have a checkup or routine visit. At the same time, many doctors have temporarily shut their practices and begun offering telehealth services to those who still need consultations and regular check-ins.
Others who have kept their practices open aren’t sure for how long it will be possible or responsible to do so.
Early in April, the pressure pushed CMS to expand Medicare and Medicaid to cover 85 additional telehealth codes — including group psychotherapy, physical therapy evaluations and prosthetic training. The move came after Congress passed a coronavirus spending bill that included $500 million in telehealth coverage and several major private insurers announced they would waive copays for virtual doctor’s visits and other telehealth services.
Potential Impacts of Expanded Telehealth
The most immediate impact of the coverage expansion will be making medical services much more accessible. Current research shows that, while in-person visits are typically more effective, telehealth is great at expanding the availability of medical services. It may also help health care facilities reduce costs and improve patient satisfaction.
Struggling rural hospitals face financial pain amidst the coronavirus outbreak. Revenue has been lost as elective procedures have been canceled since patients can’t safely visit in person for fear of being infected or spreading the disease. As a result, rural communities may lose access to critical care as the pandemic progresses.
Rural residents hurt
The financial and operational pressures on rural healthcare facilities can leave patients who are displaying COVID-19 symptoms or require ongoing care for chronic conditions with limited access to critical care, especially considering many rural residents live more than 30 miles away from the nearest hospital. Plus, rural populations are often more vulnerable to severe to serious outcomes with COVID-19. Compared to urban populations, rural Americans:
Are older: More than 20% of the population in completely rural counties are ages 65+, according to U.S. census data, compared to around 15% in mostly urban centers.
Have higher rates of: obesity, diabetes, high blood pressure, and cigarette smoking
Have increased mortality rates from: heart disease, cancer, lower respiratory disease, stroke, and unintentional injuries.
Technology must be used to solve the problem
Mobile, Alabama-based healthcare technology company CPSI understands the challenges facing rural hospitals and clinics, so the company is providing a free telehealth portal so doctors can continue to provide quality care.
While telehealth regulations were quickly changed amidst COVID-19, allowing providers to be reimbursed at $220 per remote appointment instead of at $13, telemedicine is not a reality for cash-strapped rural hospitals that:
Lack the technological infrastructure and resources required to implement telemedicine
Require a highly secure, HIPAA-compliant platform (Zoom, Skype, Microsoft Teams are not secure options)
Need a platform that operates smoothly on low-bandwidth connectivity, common in rural areas
Treat patients who don’t have computers or webcam capabilities
Rural hospitals need an affordable, secure, easy-to-use telehealth platform that can be set up in hours, not months, to give their patients quality care while allowing them to tap into a desperately needed revenue stream that could help them stay afloat. They need CPSI’s turnkey telehealth solution: Talk With Your Doc.
With the COVID-19 pandemic unleashing its impact on a global scale, numerous nations are scrambling to adopt various strategies and protocols to mitigate further spread of the virus. One common protocol initiated across more than 25 nations is social distancing.
In a bid to ensure this social distancing, worldwide economies have begun the implementation of partial or complete lockdowns. While this is considered to be a largely helpful endeavor, one challenge arising from these lockdowns is limitations in access to healthcare. This presents a significant conundrum for global populations as the need for healthcare access is becoming increasingly important in the current scenario.
Amid these concerns, however, technology presents a lucrative solution; telemedicine.
Many healthcare facilities and regulatory authorities are rapidly seeking alternative healthcare solutions to offer seamless medical aid whilst mitigating risk of exposure. Telemedicine shows immense potential in this regard, by limiting the need for hospital visits, and implementing more optimized allocations of hospital capacity to integral cases, by offering access to robust healthcare through digital means.
The telemedicine market is also witnessing great support from global regulatory authorities like WHO and CDC in recent times, in an effort to safeguard medical staff and other frontline workers, without influencing the delivery of healthcare services.
The evolution of telemedicine
Telemedicine refers to the use of software and electronic communication devices to deliver clinical services to patients, without the need to make in-person visits to the hospital. Telemedicine technology is used extensively for chronic condition management, medication management, follow-up visits, and a host of such healthcare services, via secure audio and video connections.
While telemedicine has emerged as a prominent entity only in recent years, it has been in existence for several years. The origins of the telemedicine industry can be traced as far back as the 1950s, when certain university medial centers and hospital systems began to experiment with methods to share images and information through the telephone. Two Pennsylvania health centers were among the first to achieve success with this technology, through the transmission of radiologic images via telephone.
Over time, telemedicine technologies began to evolve, and witnessed a significant turn with the rise of the internet. With the emergence of smart devices, designed to facilitate high-quality video transmission, delivery of remote healthcare solutions to patients in their workplaces, homes or assisted living facilities became more prevalent, thus presenting an ideal alternative to in-person clinical visits for both specialized and primary healthcare.
Rising risk of COVID-19 transmission through contact is necessitating the development of effective telemedicine solutions
As concerns arising from the global pandemic continue to surge, telemedicine is beginning to emerge as a lucrative and sustainable preventative and treatment solution to curb the spread of the COVID-19 virus.
Virtual care services are helping bridge the gap between the population, health systems, and physicians. These solutions enable everybody, particularly symptomatic patients, to seek medical health from the comfort of their homes and communicate seamlessly with their doctors via digital means, thus reducing the risk of exposure for both medical staff as well as the general population.
For the past month or more, doctors in the US have had their hands full with the rapid onset and spread of the coronavirus. Affecting thousands of citizens each day, it’s all hands on deck to try to treat patients in need.
With an increased attention on patients suffering from this deadly virus, however, many doctors worry about their non-coronavirus patients. From those fighting off the flu or some other virus to those with preexisting conditions like diabetes, heart disease, and cancer, lots of people aren’t getting the care they should be.
Some patients are afraid to come forward out of fear they’ll contract COVID-19, others hold off on contacting their doctor to avoid taking up precious time or available hospital beds for those they feel are in greater need right now. In any event, the concern is that there could be a lot of people out there suffering in silence. If you run a healthcare practice and have some of these same concerns, know that there are some effective solutions to help you treat and support your non-COVID-19 patients.
Many healthcare facilities across the country have implemented telehealth options. It is a digital platform that allows medical professionals to provide care and treatment to their patients remotely. Not only can this type of platform be instrumental in helping you to pre-screen potential COVID-19 patients, but it can be used to help non-coronavirus patients as well.
Advising your patients to utilize this application when in need of medical attention allows you to meet with the patient virtually and assess their health status. You can prescribe medication, provide self-care tips to treat their problem at home, or, if necessary, advise them to get to a healthcare facility or hospital for immediate attention. This prevents them from coming in the office unnecessarily (saving thousands of lives), but still provides them with an option to get medical care if they need to.
Virtual visits help providers increase productivity by adding revenue and reducing travel to different clinical settings. However, despite these obvious advantages, 2019 saw an abysmally low utilization rate of less than 10%. Things have monumentally changed. As a local physician characterized telehealth today, convenience is the new quality. Love it or hate it, telehealth is here to stay.
The primary care collaborative conducts a weekly survey of physicians, nurse practitioners, and physician assistants working in primary care on how their practices are responding to the COVID-19 outbreak. Over 80% of respondents indicate their patients accept telehealth visits and nearly half of the respondents plan to continue using telehealth after the COVID-19 crisis is controlled.
Prior to the pandemic, telehealth was seen as convenient and time efficient for patients. It also showed promise for providing access to care for various underserved populations. Today we’ve gone beyond convenience as telehealth has become a necessity for both patients and providers. Increased utilization has been made possible by the relaxation of rules and requirements by both government and commercial health plans. Notably, the use of telehealth had been restricted by design.
Health plans wanted to control how and where telehealth was offered along with who could provide the service. For the duration of the COVID-19 health emergency, most health plans are allowing telehealth to be used in place of in-person encounters. Many are waiving patient cost share and paying providers the same rate as an in-person visit.
Medicare has made the following changes effective during the COVID-19 health emergency: telehealth can be used with both new and established patients, telehealth via telephone will be reimbursed, and providers are allowed to treat patients across state lines. In addition, the Centers for Medicare and Medicaid Services (CMS) is waiving HIPAA violation penalties for utilizing technologies such as FaceTime or Skype.