Keith A. Reynolds

Nefarious characters ramped up their cyber attacks on health care institutions as 2020 came to an end. According to a report from Check Point Software Technologies LTD, there was a 45% increase in cyber attacks targeting global health care organizations from the beginning of November 2020 through the end of the year. This was more than double the increase in cyber attacks across other industries worldwide across the same period. Although the attacks involved a variety of methods, the report found the largest increase in ransomware attacks.

An October alert from the Cybersecurity & Infrastructure Security Agency (CISA), the Federal Bureau of Investigation (FBI), and the Department of Health & Human Services (HHS) said that the agencies had credible information about increased and imminent cybercrime threat to US hospitals and health care providers. These agencies believed the goal was to spread the Ryuk ransomware for financial gain.

Hospital and health systems are an attractive target because patient safety and well-being hang in the balance. In September 2020, Universal Health Services, one of the United States’ largest hospital and health care networks, was a victim of such an attack. Employees believed the attack had the hallmarks of Ryuk, according to Wired magazine. Linked to Russian cybercriminals, Ryuk first appeared in 2018. It has been used to attempt to extort large amounts of ransom from corporations with deep pockets.

The Check Point Report speculated that because these ransomware attacks result in cash windfalls for the hackers, it makes them hungrier for more. Plus, with the world’s health care systems preoccupied with the coronavirus disease 2019 pandemic, the industry has become a prime target.

Check Point provided tips to help prevent ransomware and phishing attacks:

Look for Trojan infections. Most ransomware attacks start with an initial infection by a Trojan that can occur days or weeks before the ransomware attack.

Raise your guard on weekends and holidays. Most ransomware attacks occur when information technology and security staff are out of the office.

Educate employees about malicious emails. Ensuring employees know how to identify and avoid possible ransomware attacks is critical, as many attacks start with a targeted phishing email that does not contain the malware. ❒

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In a time of increased telehealth, secure technology is more important than ever. 

Spike in Health Care Cyber Attacks

Patients are seeing telehealth as a bright spot in the nation’s response to the coronavirus disease 2019 (COVID-19) pandemic.

, patients scored telehealth services at 860 on a 1000 point scale as part of the J.D. Power 2020 U.S. Telehealth Satisfaction Study.

Unfortunately, it was not all good news. The study found that 52% of telehealth users report they have encountered at least 1 barrier to telehealth. The most common barriers included: limited services (24%), technology requirements (17%), and a lack of awareness about the cost (15%). Another 35% of telehealth patients reported they experienced a problem during a visit, and 26% reported technological-audio issues, the release reported.

“The COVID-19 pandemic has been a moment of truth for telehealth, and, by most accounts, the technology is rising to the challenge and delivering a high degree of satisfaction among those who use it,” James Beem, managing director of global healthcare intelligence at J.D. Power, explained in the release. “However, even though the public awareness with Telehealth is higher due to the influence of COVID-19, the barriers for the consumer to engage with the technology has been a consistent theme in our research.”

Patients who were at-risk gave an overall satisfaction score 117 points lower than the scores of those patients who considered themselves to be in excellent health. Healthier patients were also more likely to understand information provided during the visit, to receive clear explanations, to feel that their visits were highly personalized, and obtained a high quality diagnosis, the release reported.

Of the respondents, 46% said their top reason for choosing telehealth was safety compared with only 13% who reported similarly in 2019.

Amwell ranked the highest in satisfaction among direct-to-consumer telehealth providers with a score of 885, while Doctors on Demand came in second with a score of 879. Cigna, meanwhile, ranked highest among health insurers who provided telehealth services with a score of 867, while Kaiser Foundation Health Plan came in second with 867.

The COVID-19 pandemic has been a moment of truth for telehealth, and, by most accounts, the technology is rising to the challenge.

Patients Like Telehealth, But Barriers Still Persist

(ACP) released a position paper aimed at ensuring that electronic communication between patients and physicians are thoughtful and effective while also maintaining standards of ethics and professionalism.

American College of Physicians Ethical Guidance for Electronic Patient-Physician Communication: Aligning Expectations

and was developed by the ACP Ethics, Professionalism and Human Rights Committee (EPHRC). It makes recommendations for physicians navigating these new forms of communication with an emphasis on ethics and professionalism, privacy and confidentiality, and price considerations.

While the paper looks at using email, patient portals, texting, and messaging applications used by patients and physicians, it does not examine telemedicine, telephone, video, or other applications, according to a press release. The paper also does not discuss communication between clinicians, the release reported.

The recommendations for electronic communication in the position paper include:

They should not take the place of in-person communications;

They should only take place after discussion with the patient about expectations and appropriate uses, and with the patient’s consent;

It should occur through a method that is patient-centered and secure such as a patient-portal;

These communications should be documented in the medical record;

If these communications are done with attention to ethical and other concerns, they can help improve patient care, satisfaction, and clinical outcomes;

Electronic communications should be used by physicians and institutions to promote health equity and proactively address the socioeconomic and demographic factors that can lead to disparities in uptake and utilization; and

Physicians, patients, and institutions should recognize and address increased workload associated with electronic communication and the impact that can have on physician well-being.

“This paper is particularly timely given the COVID-19 pandemic,” Jacqueline W. Fincher, MD, MACP, president of ACP, said in the release. “E-com- munications have become necessary and powerful tools that have the potential to help improve quality, patient satisfaction and access to health information and clinicians but they must be used with care and with clear and mutual understanding of patients and clinicians.”

The paper also noted that the ACP Ethics Manual says that physicians must act in the best interest of their patients and should take care to extend standards for maintaining professional relationships and confidentiality.

A position paper presents the best ways to use electronic communication, particularly timely given the pandemic.

ACP Releases Ethical Guidance for Electronic Communication With Patients

Leaders of the American College of Physicians (ACP) say that a policy proposal they introduced earlier this year could be used to guide the US health care system, both during the COVID-19 coronavirus pandemic and afterward.

 published in Annals of Internal Medicine earlier this week, ACP leaders argued that actions outlined in the January policy paper, “

Better is Possible: The American College of Physicians Vision for the U.S. Health Care System

” could be used to improve access to care, reduce per capita health care costs, and reduce health care system complexity.

The pandemic exposed the flaws of the US health care system, including lack of universal coverage and access, socioeconomic inequalities, race- and ethnicity-based marginalization, and gendered consequences, according to lead author Sue S. Bornstein, MD.

“This widespread public health crisis has wreaked havoc on patients and left many health care systems unable to provide much needed care,” she said in a statement. “Enough is enough. The time is now to address our system’s shortcomings and enact real change.”

The policy paper calls for the US to adopt a single payer financing health care system or a publicly financed coverage option with regulated private insurance.

The need for expanding coverage is underscored by the 

 as more than 30 million people are uninsured or underinsured. That number is likely to increase, as the pandemic has led to millions of Americans losing their jobs and, thus, possibly their employer-provided insurance policies. Read more 

Policy suggestions released earlier this year could be used to guide actions during and after the COVID-19 pandemic.

Keith A. Reynolds

Articles

Spike in Health Care Cyber Attacks

Patients Like Telehealth, But Barriers Still Persist

ACP Releases Ethical Guidance for Electronic Communication With Patients

American College of Physicians Suggests Lead Health Care Reform