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Pandemic Stress, Cyberattacks Are Compounding Degradation of Care Delivery



This past September, the U.S. Department of Homeland Security’s Cybersecurity & Infrastructure Security Agency published a report designed to assess the health of the nation’s hospitals and health systems.

Perhaps unsurprisingly, the report, “Provide Medical Care is in Critical Condition: Analysis and Stakeholder Decision Support to Minimize Further Harm,” doesn’t offer encouraging news.

It finds the nationwide infrastructure enabling provision of medical care – one of CISA’s 55 National Critical Functions – to be severely strained by the COVID-19 pandemic and all the clinical, financial, workforce and supply chain challenges it has brought,

The concurrent cyber-pandemic of rampant ransomware and nation-state skullduggery has only compounded the difficulties faced by providers.

As the report notes: “Beyond the obvious consequences of disruptions to diagnostic, testing, and treatment equipment, even minor reductions in efficiency caused by cyber incidents compound to increase staff workload and degrade the system’s ability to provide medical care.”

At the upcoming HIMSS Healthcare Cybersecurity Forum, which kicks off next Monday, a CISA researcher will unpack the recent report – and offer some suggestions for how his agency can support struggling healthcare organizations.

To preview his session, “Healthcare is in Critical Condition,” Josh Corman, who has long IT security and public policy experience in the private sector, and joined CISA this past year under the CARES Act as a senior advisor and strategist, spoke with Healthcare IT News about the report and what it means.

“We do regular routine analysis of risk to the nation’s critical infrastructure and national critical functions throughout the pandemic,” Corman explained, noting that the assessment is both qualitative and quantitative. “This analysis is done for government stakeholders and decision-support within CISA, DHS and across agencies like HHS and CDC.”

Like many of the 55 other national critical functions during this time of upheaval – they include Operate Government, Generate Electricity, Provide Wireless Access Network Services and Maintain Access to Medical Records – the NCF known as Provide Medical Care “has been severely strained, stressed at various points throughout the pandemic.”

Aimed at various stakeholders – hospital leaders, healthcare providers, cybersecurity and IT professionals – the report explores several things that most who have experienced the past two years “suspected or possibly or probably thought were intuitive,” Corman said. “But now we’ve got some hard data to show the impacts that are affecting their organizations.”

The report explores several areas of stress and strains for providers. For instance, “we have the first data sizing of the relationship, the correlation between IC bed utilization and excess deaths two, four and six weeks later,” he explained.

“It’s a novel set of findings, and it’s much different than, say, pre-pandemic excess death rates by sizing the shape of that curve. We hope to make sure that people who are making choices about hospital utilization are armed with this newer consequence information.”

The strains on the care delivery system – and the excess deaths they cause – can have severe upstream effects on broader infrastructure, workforce and, potentially, national security.

“An analysis of these excess deaths on top of COVID-19 death reveals some interesting demographic slices – one of which is that one of the fastest growing groups affected by these non-COVID-19 excess deaths from degraded and delayed care are aged 25 to 44 year olds,” Corman explained.

“We also have an ethnicity breakdown that demographic is fairly representative of the nation’s critical infrastructure workers. So critical functions can be impeded by sickness and death of the workforce. In some cases, for highly specialized talent, we can’t really [just] hire more people. It can take five, 10, 15 years to train and backfill the strategic workforce.”

The goal, he said, is “inform state and local leadership on some of the impact – not just to their citizens, which is of course important, but also to identify and track and manage risk and reduce risk to the national functioning of the country for things like transportation, water, food production, medical supplies, and the like.”

No question, the pandemic has been a stressful time for the healthcare system, and has presented significant challenges that have often compromised patient care.

But here’s another question: Can cyber disruption make it worse?

“I think everyone intuitively knows that water is wet and fire is hot,” said Corman. “And that degradation can affect patient outcomes irrespective of cause.”

By way of example, he pointed to a study that explored (non-cybersecurity) disruptions to healthcare delivery, a New England Journal of Medicine article studied the effects of traffic disruptions caused by major U.S. marathons, and assessed how they affected heart attack prognoses.

“They saw that the 4.4 minute longer ambulance ride to get around the marathon route has a statistically significant increase in mortality 30 days later.”

Throughout the pandemic, in the U.S. and abroad, “unscrupulous ransom actors were targeting and hitting us hospitals pretty hard.”

In at least one case, and possibly others, we’ve seen how cyber attacks can lead to patient deaths.

“Armed with the elevated case rates and hospitalizations of the pandemic as a baseline, we were able to lean in and try to study this national experiment of protracted service disruption in hospitals,” said Corman. “The team asked, can cyber [attacks] make it worse? And the answer is yes.”

As he explained: “The way we measure that is, if we have now an instrument for measuring hospital strain associated with excess death two, four and six weeks on one hand, what we’re able to do is for some of these protracted victims, we could take a very close look for many months after an attack and in the same geography, controlling for things like the size of hospital, the type of hospital, the size hospital in the observation period across a statistically significant sampling, we can compare head to head with the same geography, same population, same time period of the pandemic.”

With head to head comparisons, said Corman, “you now are able to contrast the effects of cyber disruption to introduce delayed integrated care sufficiently high enough to be in our danger zone for excess deaths two, four and six weeks later.”

HHS and the FDA “have said for many years that cyber safety issues are patient safety issues,” he said. “But there’s been a reluctance in the field to really reconcile and rectify what we many of us intuitively have known to be true – that, yes, delayed and degraded patient care from any cause – power outages, marathons and, yes, cyber attacks – can contribute to worsen outcomes and even excess deaths.”

Corman is the co-founder of I Am The Cavalry, which describes itself as a “grassroots organization focused on the intersection of digital security, public safety and human life.”

According to its motto: “The Cavalry isn’t coming. It falls to you.”

But that’s not to say there’s no helping hands out there.

And Corman emphasizes that “CISA, the newest federal agency, is here to be your cyber defender.”

Toward that end, there are several resources highlighted in the report designed to arm healthcare professionals “with new data and motivation to go to their stakeholders and encourage them to maybe sign up for some of the free, taxpayer funded services from CISA, like our Cyber Hygiene Services.”

Another educational resource is its CISA Bad Practices page, designed to highlight “exceptionally risky” habits such as use of unsupported (or end-of-life) software, known/fixed/default passwords and credentials and, of course, reliance on single-factor authentication.

“We want stakeholders avail themselves left of boom services and advice from CISA -meet the local regional CISA team, their cybersecurity advisers, perhaps – and, right of boom, for them know who to call with resources like and other things, so that they have a plan in place before harm and can maybe mitigate and recover more quickly from harm.”

Josh Corman’s HIMSS Healthcare Cybersecurity Forum session, “Healthcare is in Critical Condition,” is scheduled for Tuesday, December 7, at 11 a.m.

Twitter: @MikeMiliardHITN
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Healthcare IT News is a HIMSS publication.

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Health Care

Singapore’s Public Health System Rolling Out the Clinician’s ZEDOC Platform



Singapore’s health tech agency Integrated Health Information Systems has partnered with Auckland-headquartered digital health firm The Clinician to deploy a patient-reported outcome and experience measures platform across the island state’s public healthcare system.


The Clinician’s ZEDOC platform, the company describes, assists healthcare providers in managing patient-generated health data outside the hospital through digitisation. Integrated with HIS, the system supports timely exchange of health data and information between providers and patients, including subjective PROMs and PREMs, objective wearable device data, and other communication or educational materials. By streamlining the digital collection of critical health data, ZEDOC is able to render real-time, actionable information crucial for improving health outcomes and experiences.

The partners are working on multiple ZEDOC integrations with existing health information systems (HIS). A privacy-preserving hybrid infrastructure has been implemented which ensures that all personally identifiable information stays within the IHiS’s private health cloud while all anonymised health data are collected through a secure commercial cloud platform.


Singapore intends to measure and improve health outcomes and patient experience with the rollout of The Clinician’s ZEDOC platform. Their partnership will “bolster patient engagement and enable clinicians to more effectively assess patients’ health status before, during and after receiving a health service – closing the loop when they are outside the hospital,” said The Clinician CEO Dr Ron Tenenbaum. It will also allow providers to deliver “more holistic and personalised care for patients by taking into account their perspectives for the first time,” he added.

To demonstrate the benefit of routine collection and analysis of PROMs, The Clinician shared that this has resulted in over 50% reduction in 90-day complications for hip and knee surgery patients in one study and a five-month improvement in the survival of cancer patients in another.

Among benefits for care providers, the ZEDOC integration will replace existing paper-based forms with an integrated digital platform that automates data capture, as well as benchmark outcomes across providers to reduce variability and waste. For patients, they can become more involved in the treatment decision-making and be informed early of health risks and warning signs.


Last month, Cabrini Health and The Alfred, two of the largest healthcare providers in the Australian state of Victoria, deployed the ZEDOC platform to automate the collection and analysis of health data from colorectal cancer patients. The installation is said to adhere to the colorectal cancer standards outlined by the International Consortium of Health Outcomes Measurement.

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EU Analysis Highlights Digital Health Lessons From COVID-19



An EU analysis has outlined the effect of COVID-19 on healthcare systems in Europe and the role of digital innovation in building their resilience.

Experts from the Organisation for Economic Co-operation and Development (OECD) and the European Observatory have published a set of 29 country health profiles, covering all EU member states, as well as Iceland and Norway. A companion report also highlights a selection of cross-country trends.

Speaking at a virtual launch event on Monday (13 December), Josep Figueras, director, European Observatory, highlighted two main lessons learnt from the use of technology in the pandemic.

Using telemedicine as an example of digital health innovation, he said the number of teleconsultations had increased in all EU countries during 2020. However in some countries, such as France, teleconsultations had decreased when lockdowns ended.

“The key issue here is how we harness and sustain innovation – how we make sure that these improvements in the use of telemedicine (as an illustration of the use of other digital technologies) can be maintained and sustained to increase the effectiveness of the health system,” Figueras said.

He also highlighted that the technology for telemedicine and other innovations was already available in many European countries before the pandemic but was not being used.

Figueras asked: “What did we do within the pandemic that literally within a couple of weeks, we got all this telemedicine in place?”

To sustain the use of telemedicine and other health technologies, he said it was important to look at the regulatory measures, financial incentives, training and changes in culture needed.

“Something the pandemic has taught us loudly and clearly is the importance of digital innovation – not only the new technologies, but the ability to implement them,” Figueras added.


The State of Health in the EU cycle is a two-year process initiated by the European Commission in 2016, designed to improve country-specific and EU-wide knowledge in healthcare.

It aims to gather data and in-depth analyses on health systems and make the information accessible to policy makers and stakeholders.


During the pandemic, digital tools have been used in the EU to boost public health measures such as the implementation of the EU Digital COVID Certificate, vaccination booking systems, and cross-border interoperability for contact-tracing apps.

There has also been investment in EU-wide COVID recovery initiatives such as the EU4Health programme.


Maya Matthews, head of unit performance, European Commission said: “COVID-19 illuminated the fact that in many European countries we do not have a strong public health system. We cannot do testing and tracing. Even surveillance is done sometimes in a very fragmented fashion.

“I think if one thing comes out of COVID-19, it’s to say that public health matters – that public health is a very important part of health systems and has not really received the attention it deserves.”

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Clinical Messaging Platform Hospify to Close, Bupa Arabia Invests in Global Ventures, and More News Briefs



Clinical messaging platform Hospify to close

British healthtech startup Hospify has announced it will close its secure clinical messaging platform on 31 January 2021.

Hospify said it suffered a decline in demand after the government suspended the UK 2018 Data Protection Act in relation to healthcare last year for the duration of the COVID-19 pandemic.

It also cited difficulties caused by “post-Brexit uncertainties surrounding the future of the UK’s data adequacy agreement with the EU”.

A statement from the Hospify team says: “It’s a sad end to a wonderful vision, a vision of universal health care communication that was both free of data exploitation and free at the point of use.”

Insurance giant Bupa Arabia invests in Global Ventures

UAE-based international venture capital firm Global Ventures has announced new investment from Bupa Arabia, the leading health insurance company in the region.

Bupa Arabia’s participation in Global Ventures Fund II as strategic partner aims to foster the healthcare ecosystem in the region and particularly in Saudi Arabia.

The investment is part of the Bupa Arabia’s strategy to participate and invest in disruptive healthcare and insurance technologies, amongst other targeted growth sectors.

Noor Sweid, Global Ventures founder and general partner, said: “Bupa Arabia shares our outlook and ambition on the digital health sector, and its potential for technology and innovation to deliver long-term economic benefits particularly in emerging markets.”

Liverpool Heart and Chest Hospital achieves EMRAM Stage 6

Specialist NHS trust Liverpool Heart and Chest Hospital (LHCH) has been awarded Stage 6 of the EMRAM, or Electronic Medical Record Adoption Model, by HIMSS.

The EMRAM measures the adoption and maturity of a health facility’s inpatient EMR capabilities from 0 to 7. Achieving Stage 6 means the trust has established clear goals for improving safety, minimising errors, and recognising the importance of healthcare IT.

Kate Warriner, chief digital and information officer said: “Digital excellence must be the cornerstone if we are to continually improve the care that we provide for our patients in the years ahead. Therefore, whilst we are rightly proud of this achievement, we have ambitions for further pioneering innovation and advancing our use of technology to become a Stage 7 hospital.”

More than $110m raised by Sheba’s ARC Innovation Center

Israel’s Sheba Medical Center has announced that six companies from its Accelerate Redesign Collaborate (ARC) Innovation Center raised more than $110 million (EUR97.2m) in 2021.

ARC brings new technologies into the hospital and community ecosystem focusing on digital health technologies including precision medicine, big data, artificial intelligence (AI), predictive analytics, telemedicine and mobile health.

Sheba MedTech startups receiving investments this year included: Aidoc, BELKIN Laser, Starget Pharma Append Medical, Innovalve Bio Medical and TechsoMed.

Professor Eyal Zimlichman, ARC director and founder, said: “The ARC Innovation Center has been focusing on ground-breaking, innovative technologies with a prime directive to redesign healthcare.”

Konica Minolta named as part of NHS Digital Documents Solutions framework

Konica Minolta Business Solutions (UK) Ltd has been named as one of 46 suppliers on the new ?5 billion Digital Documents Solutions framework.

The firm will provide solutions across five key areas: internal print, external print, digital mail room, scanning and electronic document management solutions.

Jason Barnes, head of public sector, Konica Minolta, said: “Having been chosen through a competitive tender process, we are especially pleased to be newly appointed to the LPP framework, which deepens and furthers our reach into the NHS health sector.”

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