New Jersey’s largest hospital system said Friday that a ransomware attack last week disrupted its computer network and that it paid a ransom to stop it.
Hackensack Meridian Health did not say in its statement how much it paid to regain control over its systems but said it holds insurance coverage for such emergencies.
The attack forced hospitals to reschedule nonemergency surgeries and doctors and nurses to deliver care without access to electronic records.
The system said it was advised by experts not to disclose until Friday that it had been the victim of a ransomware attack. It said that its network’s primary clinical systems had returned to being operational, and that information technology specialists were working to bring all of its applications back online.
Hackensack Meridian said it had no indication that any patient information was subject to unauthorized access or disclosure.
It quickly notified the FBI and other authorities and spoke with cybersecurity and forensic experts, it said.
Hackensack Meridian operates 17 acute care and specialty hospitals, nursing homes, outpatient centers, and the psychiatric facility Carrier Clinic.
an artificial intelligence company based in Florida, has partnered with Googlevto create an autonomous patient monitoring system. By combining multiple sensors in a patient’s room and neural network data analysis, the system can identify and predict accidents and clinical events, in some cases warning healthcare staff before an incident happens.
Preventable accidents and medical issues in healthcare facilities result in thousands of patient deaths and significant patient suffering every year. These include falls, infections, and pressure ulcers. While such issues are theoretically avoidable, in many cases it is difficult or impossible for healthcare staff to identify and anticipate every such instance, and in many cases, they can only hope to react to such circumstances once they arise.
To address this, the patient monitoring system developed by care.ai allows patient rooms to be “self aware,” whereby patients are automatically monitored 24 hours a day through advanced sensors, and AI identifies and anticipates mishaps and issues, providing healthcare staff with advanced warning.
The company claims that the system allows healthcare staff to have more time to focus on their patients’ specific needs, rather than constantly keeping an eye on them or reacting to unforeseen events. Moreover, it should also allow healthcare staff to be much more proactive, and lead to lower overall levels of avoidable mishaps in healthcare facilities.
Medgadget had the opportunity to talk to Chakri Toleti, Founder and CEO of care.ai, about the company’s technology.
Conn Hastings, Medgadget: What inspired you to develop a patient monitoring system?
Chakri Toleti, care.ai: In early 2018, I received
a call that my mother in India had fallen and remained on the bathroom floor
for half an hour before her caregiver found her. Even the best medical
professionals simply can’t be everywhere at once, so they are often delayed in
responding to patient issues. This was the catalyst for care.ai, fueled by the
idea that patients should be able to maintain independence and privacy while
still being kept safe.
Other industries, like transportation and aviation,
have really transformed because of AI. Healthcare, however, has been slower to
adopt it. I considered the autonomous
driving – how self-driving technology constantly scans and monitors its
environments, responding to pedestrians, roadblocks, debris, etc. I thought,
“what if we could bring the autonomous monitoring of a self-driving car to a hospital?”
I created care.ai to turn every room into a Self Aware RoomTM.
Medgadget: Please give us some background on the types of incident the system is designed to anticipate.
Chakri Toleti: These
are the few use cases that we have deployed: staff efficacy, fall prevention, pressure
ulcer prevention, and hand sanitization monitoring.
In phase 2 we will be
deploying other use cases such as patient elopement prevention (wandering
patients), security violations and visitor management.
Medgadget: What type of sensors are included?
Chakri Toleti: care.ai’s sensors use the
most advanced technology of any solution in a healthcare setting. We use a wide
range of propriety sensors within our patented hardware and software framework.
We are leveraging NVIDIA’s Jetson platform as a core compute engine and further
accelerating the inferencing of the sensor data using Coral’s Edge TPU.
Medgadget: Please give us a basic overview of how the AI system learns to anticipate incidents in a patient’s room.
Chakri Toleti: care.ai’s purposefully architected deep neural networks are trained on our propriety library of behavioral data – in fact, it’s the world’s largest library of human behavior data in a healthcare setting. Using edge-computing framework, care.ai’s deep neural networks deliver predictive results within nanoseconds. Using this proprietary library, the sensors identify recognized behaviors and immediately send relevant alerts to the appropriate care team members. The alerts are sent through a mobile app, SMS, desktop app, or integrated into existing HIS solutions using our SDK/APIs.
Medgadget: How has the collaboration with Google helped the system?
Chakri Toleti: We chose to work with Google because their software and hardware frameworks for AI – and now their capability to bring it to the edge – meet care.ai’s needs for the scale, accuracy and performance necessary to build an enterprise-class platform. Coral’s edge TPU has been instrumental for us to scale, allowing us to preserve patients’ privacy while still conducting constant monitoring and processing.
Medgadget: Is the system in use at present? How do you deal with patient confidentiality and data security?
Chakri Toleti: Consulate Health Care, a leading provider of long-term healthcare services, is currently piloting care.ai. care.ai’s platform is the most scalable and secure AI solution in Healthcare, we process all of our data on the edge on a highly secure and custom-built operating system and publish the deidentified inferenced data in a secure and HIPAA complaint framework back to the server.
Electronic health records may improve quality and efficiency for doctors and patients alike—but physicians give them an “F” for usability and they may contribute to burnout, according to new research.
By contrast, in similar but separate studies, Google’s search engine earned an “A” and ATMs a “B.” The spreadsheet software Excel got an “F.”
“A Google search is easy,” says Edward R. Melnick, assistant professor of emergency medicine and director of the Clinical Informatics Fellowship at Yale University. “There’s not a lot of learning or memorization; it’s not very error-prone. Excel, on the other hand, is a super-powerful platform, but you really have to study how to use it. EHRs mimic that.”
Usability ratings for everyday products measured with the System Usability Scale. Google: 93%; microwave: 87%; ATM: 82%; Amazon: 82%; Microsoft Word: 76%; digital video recorder: 74%; global positioning system: 71%; Microsoft Excel: 57%; electronic health records: 45%. (Credit: Michael S. Helfenbein)
There are various electronic health record systems that hospitals and other medical clinics use to digitally manage patient information. These systems replace hard-copy files, storing clinical data, such as medications, medical history, lab and radiology reports, and physician notes.
The systems were developed to improve patient care by making health information easy for healthcare providers to access and share, reducing medical error.
But the rapid rollout of EHRs following the Health Information Technology for Economic and Clinical Health Act of 2009, which pumped $27 billion of federal incentives into the adoption of EHRs in the US, forced doctors to adapt quickly to often complex systems, leading to increasing frustration.
Two hours of personal time
According to the study, physicians spend one to two hours on EHRs and other deskwork for every hour spent with patients, and an additional one to two hours daily of personal time on EHR-related activities.
“As recently as 10 years ago, physicians were still scribbling notes,” Melnick says. “Now, there’s a ton of structured data entry, which means that physicians have to check a lot of boxes.
“Often this structured data does very little to improve care; instead, it’s used for billing. And looking for communication from another doctor or a specific test result in a patient’s chart can be like trying to find a needle in a haystack. The boxes may have been checked, but the patient’s story and information have been lost in the process.”
The AMA, along with researchers at the Mayo Clinic and Stanford University, surveys over 5,000 physicians every three years on topics related to burnout. Most recently, the burnout rate was 43.9%—a drop from the 54.4% of 2014, but still worryingly high, researchers say. The same survey found that burnout for the general US population was 28.6%.
Electronic health records and burnout
Researchers also asked one quarter of the respondents to rate their EHR’s usability by applying a measure, System Usability Scale (SUS), previously used in over 1,300 other usability studies in various industries.
Users in other studies ranked Google’s search engine an “A.” Microwave ovens, ATMs, and Amazon got “Bs.” Microsoft Word, DVRs, and GPS got “Cs.” Microsoft Excel, with its steep learning curve, got an “F.”
In Melnick’s study, EHRs came in last, with a score of 45—an even lower “F” score than Excel’s 57.
Further, EHR usability ratings correlated highly with burnout—the lower physicians rated their EHR, the higher the likelihood that they also reported symptoms of burnout.
The study found that certain physician specialties rated their EHRs especially poorly—among them, dermatology, orthopedic surgery, and general surgery.
Specialties with the highest SUS scores included anesthesiology, general pediatrics, and pediatric subspecialties.
Demographic factors like age and location matter, too. Older physicians found EHRs less usable, and doctors working in veterans’ hospitals rated their EHR higher than physicians in private practice or in academic medical centers.
Benchmarking physicians’ feelings about EHRs will make it possible to track the effect of technology improvements on usability and burnout, Melnick says.
“We’re trying to improve and standardize EHRs,” Melnick says. “The goal is that with future work, we won’t have to ask doctors how they feel about the EHR or even how burned out they are, but that we can see how doctors are interfacing with the EHR and, when it improves, we can see that improvement.”
“There were words we couldn’t say at Theranos, like ‘biology,’ ‘pipette,’ ‘research,’” Shultz recalled. “And we weren’t supposed to talk to other people at Theranos about what you were doing.”
Still, the two didn’t have any other career experience, so it took a while for the red flags to add up, Cheung said.
Now, with the former leadership of Theranos waiting for a 2020 trial, Cheung and Shultz have established an organization they call Ethics in Entrepreneurship, hoping to prevent other tech and health startups and employees from going through what they did.
“We’re all here because we want to make an impact and we want to do good and we have good intentions, but making sure you have that strong vision and figuring out how to maintain that” is challenging, Cheung said. “You have to figure out how to stick to those morals and standards and values despite the chaos.”
Though they’re far from having all the answers at this point, they pointed to some basics that can be applied to almost any company:
Discretion from investors: “If the average age of the board is 80, maybe insist on a board seat,” Shultz said. “Or insist on younger blood.”
So-called vanity boards are popular in Silicon Valley, Cheung agreed, but especially in a highly regulated space like health care, “you need the right people asking the right questions.”
Be proactive: Think about the impacts a startup will have on customers, investors, employees and society. It’s better to think about these ethical issues early on in the process, Cheung said, rather than reactively.
Consider realigning incentives: Shultz and Cheung agree that there should be a way within the investment landscape to prevent an unethical situation from going too far. For example, if someone was personally profiteering or committing egregious actions, there could be a system in place for investors to pull back money. “There need to be ways to keep people accountable, to nudge them to good behavior,” Cheung said.
Think before investing: When people were investing in Theranos, Cheung pointed out, it was during a time when investors were scared of losing the next opportunity to buy into an Amazon. “There was not a lot of deep thinking about how to invest in tech companies,” she said. Theranos should serve as a warning to potential investors that they need to ask the questions before signing the check.
Create a culture of healthy disagreement: Shultz has started a new company, and while it only has three employees so far, one of his primary missions is to establish a culture in which people are allowed to disagree — even with the boss. “My lab bench scientist and I get into some arguments that are pretty intense, but I tell him it’s really healthy — and we can move on,” he says. How do you scale that for a bigger company? “That’s the hard question,” Cheung said. “But the biggest one is, do you have a way for employees to report problems? Are the right mechanisms in place to compile evidence, and is there investigation and followup?” An ethics hotline, she said, is one way to do that.
Despite spending most of his 20s wrapped up in the Theranos scandal, Shultz maintains a sense of optimism.
“So many things had to go wrong [in the Theranos case] that I think it’s unlikely something like this would happen again,” he said. “Though maybe I’m naive.”
Moderator Rebecca Jarvis of ABC asked the pair whether they thought former Theranos CEO Elizabeth Holmes should go to jail.
“There has to be some justice,” Cheung said, to great applause from the audience. “There has to.”TrendMD v2.4.3
As voters fume about the high cost of health care, politicians have been targeting two well-deserved villains: pharmaceutical companies, whose prices have risen more than inflation, and insurers, who pay their executives millions in salaries while raising premiums and deductibles.
Although the Democratic presidential candidates have devoted copious airtime to debating health care, many of the country’s leading health policy experts have wondered why they have given a total pass to arguably a primary culprit behind runaway medical inflation: America’s hospitals.
Data shows that hospitals are by far the biggest cost in our $3.5 trillion health care system, where spending is growing faster than the gross domestic product, inflation, and wage growth. Spending on hospitals represents 44% of personal expenses for the privately insured, according to the Rand Corp.
A report this year from researchers at Yale and other universities found that hospital prices increased a whopping 42% from 2007 to 2014 for inpatient care and 25% for outpatient care, compared with 18% and 6% for physicians.
So why have politicians on both the left and right let hospitals off scot-free? Because a web of ties binds politicians to the health care system.
Every senator, virtually every congressman and every mayor of every large city has a powerful hospital system in his or her district. And those hospitals are as politically untouchable as soybean growers in Iowa or oil producers in Texas.
As hospitals and hospital systems have consolidated, they have become the biggest employers in numerous cities and states. They have replaced manufacturing as the hometown industry in a number of Rust Belt cities, including Cleveland and Pittsburgh.
Can Kamala Harris ignore the requests of Sutter Health, Kaiser Permanente, UCLA or any of the big health care systems in California? Can Elizabeth Warren ignore the needs of Partners HealthCare, Boston’s behemoth? (Bernie Sanders may be somewhat different on this front because Vermont doesn’t have any nationally ranked hospitals.)
Beyond that, hospitals are often beloved by constituents. It’s easy to get voters riled up about a drugmaker in Silicon Valley or an insurer in Hartford. It’s much riskier to try to direct their venom at the place where their children were born, that employed their parents as nurses, doctors and orderlies, that sponsored local Little League teams, that was associated with their Catholic Church.
And, of course, there’s election money. Hospital trade groups, medical centers and their employees are major political donors, contributing to whichever party holds power — and often to the out-of-power party as well. In 2018, PACs associated with the Greater New York Hospital Association, and individuals linked to it, gave $4.5 million to the Democrats’ Senate Majority PAC and $1 million to their House Majority PAC. Its chief lobbyist personally gave nearly a quarter of a million dollars to dozens of campaigns last year.
Sen. Sanders has called on his competitors for the Democratic nomination to follow his lead and reject contributions from pharma and insurance. Can any candidate do the same for hospitals? The campaign committees of all ten candidates participating in the upcoming Democratic debate have plentiful donations linked to the hospital and health care industry, according to Open Secrets.
But the symbiosis between hospitals and politicians operates most insidiously in the subtle fueling of each other’s interests. Zack Cooper, a health economist at Yale, and his colleagues looked at this life cycle of influence by analyzing how members of Congress voted for a Medicare provision that allowed hospitals to apply to have their government payments increased. Hospitals in districts of members who voted “yea” got more money than hospitals whose representatives voted “nay,” to the collective tune of $100 million. They used that money to hire more staff and increase payroll. They also spent millions lobbying to extend the program.
Members who voted yea, in turn, received a 25% increase in total campaign contributions and a 65% increase in contributions from individuals working in the health care industry in their home states. It was a win-win for both sides.
To defend their high prices, medical centers assert that they couldn’t afford to operate on Medicare payments, which are generally lower than what private insurers pay. But the argument isn’t convincing.
The cost of a hospital stay in the United States averaged $5,220 a day in 2015 — and could be as high as over $17,000, compared with $765 in Australia. In a Rand study published earlier this year, researchers calculated that hospitals treating patients with private health insurance were paid, overall, 2.4 times the Medicare rates in 2017, and nearly three times the rate for outpatient care. If the plans had paid according to Medicare’s formula, their spending would be reduced by over half.
Most economists think hospitals could do just fine with far less than they get today from private insurance.
While on paper many hospitals operate on the thinnest of margins, that is in part a choice, resulting from extravagance.
It would be unseemly for these nonprofit medical centers to make barrels of money. So when their operations generate huge surpluses — as many big medical centers do — they plow the money back into the system. They build another cancer clinic, increase CEO pay, buy the newest scanner (whether it is needed or not) or install spas and Zen gardens.
Some rural hospitals are genuinely struggling. But many American hospitals have been spending capital “like water,” said Kevin Schulman a physician-economist at Stanford. The high cost of hospitals today, he said, is often a function of the cost of new infrastructure or poor management decisions. “Medicare is supposed to pay the cost of an efficient hospital,” he said. “If they’ve made bad decisions, why should we keep paying for that?”
If hospitals were paid less via regulation or genuine competition, they would look different, and they’d make different purchasing decisions about technology. But would that matter to medical results? Compared with their European counterparts, some American hospitals resemble seven-star hotels. And yet, on average, the United States doesn’t have better outcomes than other wealthy nations. By some measures — such as life expectancy and infant mortality — it scores worse than average.
As attorney general in California, Kamala Harris in 2012 initiated an antitrust investigation into hospitals’ high charges. But as a senator and presidential candidate, she has been largely silent on the issue — as have all the other candidates.
As Uwe Reinhardt, the revered Princeton health economist who died in 2017, told me, “If you want to save money, you have to pay less.” That means taking on hospital pricing.
So fine, go after drugmakers and insurers. And, for good measure, attack the device makers who profit from huge markups, and the pharmacy benefit managers — the middlemen who negotiate drug prices down for insurers, then keep the difference for themselves.
But with Congress returning to Washington in the coming days and a new Democratic debate less than two weeks away, our elected officials need to address the elephant in the room and tell us how they plan to rein in hospital excesses.
Elisabeth Rosenthal is editor in chief, Kaiser Health News. =============================================================================================
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