Tag Archives: Healthcare

Intermountain Healthcare relies on virtual hiring to fill CIO role

Intermountain Healthcare will be onboarding a new CIO at the end of this month, making him the first senior executive to be hired virtually by the healthcare organization.

Ryan Smith will take over for longtime Intermountain Healthcare CIO Marc Probst, who announced his retirement earlier this year, before the COVID-19 outbreak and the mandates for nonessential employees to work from home. With remote work in full swing, Dan Liljenquist, senior vice president and chief strategy officer at Intermountain, said the healthcare system had to rely exclusively on virtual hiring to pick its new healthcare CIO.

Smith is a known entity to the healthcare organization. He served in IT leadership roles at Intermountain for 19 years from 1994 to 2013. But the hiring team felt his five years as CIO at Banner Health in Phoenix and, more recently, his two years as senior vice president at Health Catalyst, an analytics software and services provider in Salt Lake City, best prepared him for the position.

Smith will start his new role June 29 the same way he was hired: virtually. Smith said the virtual hiring process has been “quite different” from the traditional recruiting process he’s used to.

“Typically, you would fly in for your on-site interview with key executives in a formal setting,” he said. “It’s a strange feeling to put on a full suit, dress shirt and tie to only walk to another room in your home for an interview where you’re the only one physically in the room.”

Onboarding a CIO during a crisis

But going through the virtual hiring process had its benefits for Smith. It made him realize the importance of video conferencing technology — both the criticality of it running smoothly and the new challenges it presented such as making sure the background is appropriate for the meeting.

Soon-to-be Intermountain Healthcare CIO Ryan SmithRyan Smith

And, Smith said, with every interview he grew more comfortable with the virtual hiring process.

“Coming out of each round of virtual interviews, I was surprised at just how much more comfortable and down to earth the conversations felt,” he said. “There are definitely some benefits to this form of interviewing, while also posing some new challenges.”

Liljenquist said the Intermountain Healthcare hiring team used technology to find and interview finalists for the CIO role, even when it came down to final selection.

It’s a strange feeling to put on a full suit, dress shirt and tie to only walk to another room in your home.
Ryan SmithIncoming CIO, Intermountain Healthcare

“All of us know Zoom and Webex and Microsoft Teams better than we ever thought we would,” he said.

Liljenquist said Smith will be using those same tools to connect to and lead his team. While Smith said it will be different starting his new role remotely, he sees his existing relationships with team members from his time at Intermountain as an advantage. He’s also planning for a remote start as CIO to come with challenges, specifically with “rounding,” where he would normally meet with providers and discuss in person what technology is working and what needs to improve.

As part of the final selection for the new CIO, Liljenquist said Intermountain required Smith and other finalists to give a virtual presentation on what health IT would look like post-COVID-19.

Intermountain Healthcare senior vice president and chief strategy officer Dan LiljenquistDan Liljenquist

In his presentation, Smith said he focused on new realities the healthcare industry will face in the coming months, such as reductions in medical care, the continuation of remote work, increases in digital expectations from patients and increases in merger and acquisition activity across the industry.

“We talked about recommended approaches for leading the IT team in addressing this new normal, entailing business alignment and partnership, innovation, accountability, transparency, customer focus and fiscal responsibility,” Smith said.

In a news release, Intermountain Healthcare said Smith will lead the care transformation information systems team, while partnering with others to “implement innovative digital, data and technology platforms and solutions” that align with the organization’s strategic goals.

“There’s never been a time in our industry when there’s been such a great dependency on the IT organization’s ability to be flexible, to rapidly innovate and to drive results in short periods of time,” Smith said. “I think most of the plans I had in mind coming into this opportunity are still relevant, but the priorities may need to shift given the nature of the environment we find ourselves in.”

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COVID-19 could be a watershed moment for telehealth policy

Healthcare stakeholders are calling for telehealth policy changes made during the COVID-19 pandemic to remain even after the pandemic ends.

Since March, federal organizations such as the U.S. Department of Health and Human Services (HHS) have taken steps to provide patients access to healthcare without having to leave their homes. Efforts were considered temporary and include expanding telehealth service coverage, waiving HIPAA penalties for using commercial video conferencing technologies, and provisioning millions of dollars to healthcare systems for expanding telehealth services.

Now, as regulators consider how to move forward after the pandemic, stakeholders such as the College of Healthcare Information Management Executives (CHIME) are asking that some temporary telehealth policy changes specifically from the Centers for Medicare & Medicaid Services (CMS) be made permanent.

Changes to telehealth policy

John Kravitz, CIO at Geisinger Health System in Danville, Penn., and chairman of the CHIME board of trustees, said before COVID-19, Geisinger offered telemedicine services in a limited capacity. Widescale adoption at Geisinger, as with other healthcare systems, was challenging because insurance coverage for telehealth services wasn’t widely supported.

When COVID-19 hit and patients were asked to stay home as much as possible, telehealth use at Geisinger saw a dramatic increase, according to Kravitz.

Kravitz said what helped Geisinger scale up its telehealth services were telehealth policy changes handed down by departments within HHSincluding CMS. Federal regulators saw an opportunity for patients to continue getting treatment while adhering to state mandates to stay home, thus relaxing certain restrictions, such as CMS allowing clinicians to provide telehealth services to Medicare patients in states where they are not licensed. They also made it easier for healthcare organizations to receive reimbursement for telehealth treatments.

Geisinger Health System CIO John KravitzJohn Kravitz

Before the pandemic, Geisinger conducted 1,000 telemedicine visits a month. Now, the organization conducts 2,000 per day, Kravitz said.

“We’re hopeful that this is being supported as the new normal — to [provide] this kind of service for our patients and continue to get compensated for it,” Kravitz said. “We’ve seen good, positive outcomes [and] great response to this by the providers. And, more importantly, patients are willing to do it.”

Kravitz’s position led him to co-write a letter with CHIME president and CEO Russell Branzell to CMS Administrator Seema Verma. In their letter, they stressed the need for making the temporary telehealth policy changes by CMS long-standing. The letter was submitted to CMS in response to two interim rules the organization published that addressed regulatory and policy changes made because of the pandemic, including telehealth policies.

“The increased use of telehealth has moved the country further into 21st Century medicine,” the letter states. “The flexibilities are reducing burdens on providers and patients alike and reverting to pre-COVID telehealth policies will be seen as a step backward.”

One telehealth policy change CHIME supported was to do away with Medicare’s originating site policy. Under typical Medicare policy, a patient who receives a telehealth visit must participate in the visit at what’s considered a “telehealth originating site,” often a medical facility in a rural area. Rather than connecting a patient from their homes to a provider, the goal of the policy was to connect patients at smaller medical facilities with larger facilities or specialists.

CHIME “strongly supports” doing away with the originating site requirements and asked that a more flexible, permanent policy be established allowing Medicare patients to be treated via telehealth no matter the location.

Buchanan Ingersoll & Rooney attorney Heather Alleva Heather Alleva

Heather Alleva, an attorney specializing in federal healthcare regulation at Buchanan Ingersoll & Rooney PC in Philadelphia, said one of the most impactful waivers CMS instituted was the originating site telehealth policy waiver.

“Not only in the past has a patient needed to be located in a particular geographic area, limited to rural areas or outside of metropolitan areas, but they also had to be located in a particular type of medical setting,” Alleva said. “Originating site waivers have made a really big shift in that.”

Although stakeholders are advocating for some of the telehealth policy changes to remain permanent, CMS and other federal regulators, as well as insurance companies, are using the pandemic to test the viability of expanded services such as telehealth, according to Alleva. What policy changes become permanent will likely result from demand for services, she said.

The road ahead

Alleva believes how the future of telemedicine will unfold is unclear. On the one hand, outpatient and non-emergency services are beginning to reopen, and patients will likely revert to traditional types of care, lowering the demand for telehealth services, she said.

I think we would be making a big mistake to go back; I really feel that strongly.
John KravitzCIO, Geisinger Health System

On the other hand, Medicare patients who have benefited from telehealth services, such as elderly patients who can no longer drive to appointments, will push the demand for continued services post-pandemic.

“Telemedicine will be in greater demand among people who have really benefited from it,” she said. “I think that’s the reason you’re seeing funding; people are seeing there are access points to care that can be delivered via telehealth.”

Forrester analyst Arielle Trzcinski Arielle Trzcinski

Forrester Research analyst Arielle Trzcinski said during the peak of the pandemic in March and April, telehealth service vendors saw mostly COVID-19-related visits. Now, vendors are seeing a “big shift” toward general, routine care and chronic care management, which will likely play a role in decisions about telehealth policies moving forward.

“We’re seeing people turn to virtual care for those types of reasons more frequently now,” Trzcinski said. “If anything, this past month of May and [into] June will continue to be a pivotal moment to watch and see how people are changing their behavior and starting to turn toward virtual care first versus going in-person to a clinic.”

Geisinger’s Kravitz said the telehealth policy changes have been monumental in advancing adoption of telehealth services and that telemedicine is “the future” of healthcare.

“I think we would be making a big mistake to go back; I really feel that strongly,” Kravitz said. “People are finally saying this technology really works and we can really utilize it, so why wouldn’t we?”

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Pandemic could alter healthcare CIO terrain

Healthcare CIOs started 2020 with a roadmap for health IT projects that then took a sharp turn because of the COVID-19 pandemic.

David Chou, CIO at Harris Health System in Houston, Texas, and former principal analyst at Constellation Research Inc., said healthcare CIOs have adjusted their focus away from longer-term projects and toward day-to-day technologies and priorities that enable operations to continue. The pandemic could also be a catalyst for transforming the role of the CIO, making a strong case for healthcare IT leaders to push out of the back office and become executive partners, Chou said.

In this Q&A, Chou, who started as CIO at Harris Health System in May, discusses what tools CIOs are looking at right now as well as how the pandemic will have a lasting effect on health IT and the role of CIO.

What trends or technologies are healthcare CIOs paying attention to right now?

David ChouDavid Chou

David Chou: Virtual care, I think that is definitely here to stay. The industry has been waiting for it. Adoption has been slow with maybe some resistance, but I would say now people are going to go full speed ahead and there is a lot of emphasis there. Remote patient monitoring, anything that’s going to improve the wellness of patients without having to see a doctor, those types of initiatives will definitely be there.

I think a lot of CIOs may also recognize [areas] where they don’t have the proper foundation in place to support these virtual initiatives. … So there are a lot of investments in the necessary foundation to really scale, for example, a remote workforce from 3,000 to 18,000. You’ve got to have the right foundation to be able to scale that properly in an expeditious manner. Foundational technology is top-of-mind right now versus any new shiny object.

What are some of those foundational technologies CIOs are looking at?

Chou: The infrastructure networks — you have to be thinking about utilizing software. You hear about software-defined networks where you can roll out a new site and manage the flow of traffic utilizing software. Really scale up or scale down your site easily. That’s going to be huge, and what people should be thinking about in terms of next-generation infrastructure.

Foundational technology is top-of-mind right now versus any new shiny object.
David ChouCIO, Harris Health System

Are CIOs doubling down on tools they have versus bringing in new technologies?

Chou: Definitely [doubling down] for the later part of this year and maybe Q1, Q2 of next year. I think there’s enough work in terms of deploying and optimizing what you already have in-house rather than going out and buying the new shiny thing people may be thinking about.

What will CIOs be looking at to help healthcare systems reopen for routine, in-person care?

Chou: Some organizations are going to have to mature their data platforms, whether it’s business intelligence or just enterprise analytics because that is going to help drive decision-making. … There will be a lot of emphasis on making data available so users can take action. That’s going to be critical as things are starting to open up.

Organizations have to reevaluate their business models too. Coming into the start of this year pre-COVID, there was a lot of emphasis on modernizing their back office. [For example,] moving toward ERP is probably on everyone’s agenda in the healthcare provider world within the next two to three years. That may be on pause, but this may also be a good time to reflect on that. That’s not just updating a system, it’s about reevaluating your supply chain that has probably not changed in the last 15 years. You have to redesign the process to be more efficient in today’s new world. You can only do that with the right data in place to make those decisions, but also to transform the organization’s process. That’s the hard part.

How do you think this pandemic will impact the role of the CIO?

Chou: I would say there’s probably going to be a change in expectation for IT and CIO leaders. The traditional philosophy and traditional management of just keeping the lights on is probably not going to fare well in the new era where [organizations] are looking at technology to be a competitive advantage and a differentiator. The CIO that can really do that can help organizations maximize their investment and are going to be key drivers and partners for the CEO and the executive team. The ones who are not able to do that and are focused on managing technology without understanding the true impact, I would say they may not be around their seats much longer.

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Imprivata and Azure AD help healthcare delivery organizations deliver safe and secure care

As hospitals and other healthcare delivery organizations accelerate their adoption of virtual care and mobile devices in response to the COVID-19 outbreak, it’s critical that providers can access cloud and on-premises apps quickly and securely. Imprivata is a healthcare-focused digital identity company that addresses this need. For today’s “Voice of the ISV” blog, I invited Kristina Cairns and Mark Erwich of Imprivata to provide insight into how Imprivata’s solutions are helping healthcare organizations deliver care beyond the four walls of the hospitals.

Supporting healthcare delivery organizations during COVID-19

By Kristina Cairns, Director of Product Marketing, Imprivata and Mark Erwich, VP Marketing, Imprivata

In response to COVID-19, hospitals and clinics have turned to remote tools to care for a surge of patients, while protecting the health of staff. These tools let clinicians connect remotely with patients, care teams, and other organizations, but they can be difficult to securely access from shared workstations or mobile devices, such as tablets. Imprivata digital identity solutions simplify access while maintaining security, so clinicians can deliver quality care safely and conveniently—no matter where they are located.

At the same time, healthcare staffing demands are skyrocketing, and these needs must be met in real time. This can mean quickly adding, or provisioning, new or re-allocated staff and ensuring they have proper access to applications, immediately. Once the crisis is over, these same staff will need to be de-provisioned to ensure security and compliance requirements are met.

Imprivata is a digital identity company that focuses on healthcare. We employ doctors and nurses who have a real-world understanding of the unique needs of hospital environments. Our solutions are designed to work with healthcare workflows and regulations, so hospitals can get up and running with new tools and upgrades, fast. In these challenging times, we’ve partnered with Microsoft to provide an integrated identity and access management platform that meets the needs of healthcare organizations. Our joint solutions make it easy to connect to healthcare’s existing identity and application data and automate at scale. Healthcare providers can use our platforms to address unique demands, such as:

  • Saving precious time in hospitals: Accessing necessary apps quickly while healthcare providers move between clinical workstations and new networked devices at the point of patient care.
  • Protecting healthcare staff and patients: Identifying providers potentially exposed to COVID-19.
  • Scaling up remote work and virtual care: Providing remote access to a diverse set of tools spanning on-premises and cloud infrastructure as providers and patients move outside of traditional healthcare environments.
  • Simplifying role-based access identity management: Securely manage access for temporary workers and existing staff who change roles or departments.

Saving precious time in hospitals

Healthcare workers are busy in the best of times. They juggle administrative tasks with a full day of patient care. As the pandemic has driven up the number of patients admitted to hospitals, time has become even more precious. Imprivata OneSign is a single sign-on (SSO) solution that enables care providers to spend less time with technology and more time with patients.

During a shift, healthcare workers use several cloud and on-premises applications including business and enterprise applications, electronic health records, medical imaging, patient management, and other systems. Each of these apps in this hybrid environment often requires a unique username and password. Imprivata OneSign eliminates the need for clinicians to memorize and manually enter their credentials. They can sign in once to access all their on-premises and cloud apps, including Microsoft Teams, Office 365, and 3,000+ Microsoft Azure Active Directory (Azure AD) Marketplace applications. No Click Access™ lets them sign in with a badge or fingerprint making it faster to access applications and workflows.

Protecting healthcare staff and patients

As healthcare delivery organizations treat patients under evaluation for COVID-19, they must also safeguard the health of clinicians. Yale New Haven Health is using Imprivata OneSign reporting capabilities to identify exactly where and when specific users accessed specific workstations in different patient care zones in the clinical environment. By combining these data with workstation mapping and electronic health record data, Yale can more accurately identify all providers potentially exposed to COVID-19 and take necessary actions.

Scaling up remote work and virtual care

To limit the spread of COVID-19, administrative roles at clinics and hospitals have migrated to remote work when possible. Care providers have rapidly scaled up virtual care services to provide non-emergency healthcare consultations. These providers need to access systems on personal laptops, mobile devices, and temporary devices in temporary care sites. It’s important that devices and individuals are authenticated to protect sensitive data and apps.

Imprivata Confirm ID for Remote Access improves security by enabling multi-factor authentication for remote network access, cloud applications, Windows servers and desktops, and other critical systems and workflows. Imprivata Confirm ID for EPCS (electronic prescribing of controlled substances) supports Drug Enforcement Agency (DEA)-compliant two-factor authentication methods so providers can quickly prescribe drugs using EPCS workflows. To support healthcare organizations during this crisis we are offering Imprivata Confirm ID licenses for free.

 

Simplifying role-based access identity management

As the number of patients increases, hospitals are rapidly re-assigning workers within the organization, while on-boarding clinicians from lower utilized hospitals. Healthcare organizations need easy and secure ways to manage user roles as they scale up and provision temporary workers.

Imprivata Identity Governance is an end-to-end solution with granular, role-based access controls and automated provisioning and de-provisioning. Streamlined auditing processes and analytics enable faster threat evaluation and remediation. These capabilities allow IT to respond to the needs of the organization without sacrificing security. Imprivata Identity Governance ensures that, on day one, the right users have the right access to the right on-premises and cloud applications, and the audit trail to prove it.

Imprivata Identity Governance can now be hosted in an Azure environment, unlocking scalability and flexibility for healthcare enterprises.

Making healthcare technology available to everyone

The following resources can help hospitals and clinics move quickly to support patient care beyond the four walls of the hospitals:

Learn more

Solutions like the Imprivata Identity and Access Management platform, Microsoft Azure AD, and Microsoft Teams are helping keep healthcare workers productive and safe as they confront the current crises. As healthcare evolves, Microsoft and Imprivata will continue to innovate together to further enhance scenarios for in-person and remote access.

Learn more about Microsoft’s COVID-19 response and Imprivata’s COVID-19 response.

Read about capabilities in Teams that support healthcare workers and other integrations between Microsoft and Imprivata.

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Author: Microsoft News Center

CIOs should plan for a spike in healthcare cyberattacks

Healthcare organizations face a growing risk of healthcare cyberattacks during the coronavirus pandemic.

The federal government is relaxing regulations so that providers can treat patients from home and use consumer-grade technologies like Skype and FaceTime. The measures are aimed at keeping providers and patients at home as much as possible to slow the spread of COVID-19. But there is also a downside to making healthcare more accessible: The measures are creating more points of entry into healthcare systems for cyberattackers.

Before the coronavirus outbreak, the healthcare industry was already one of the most likely industries to be attacked. The industry pays the highest cost to detect, respond to and deal with the fallout of a data breach, averaging just under $6.5 million per breach, said Caleb Barlow, president and CEO of healthcare cybersecurity firm CynergisTek.

Caleb BarlowCaleb Barlow

Now in the midst of a pandemic, the healthcare industry is more vulnerable than ever, and cyber criminals are likely laying the groundwork for major healthcare cyberattacks.

“If you put yourself in the mindset of an attacker right now, now is actually not the time to detonate your attack,” Barlow said. “Now is the time to get on a system, to move laterally and to elevate your credentials, and that’s likely exactly what they’re doing. There are a lot of indicators of that. We’ve seen a significant rise in COVID-19-focused phishing, both that is targeting individuals as well as institutions.”

There is not going to be a plea to bad guys of, ‘Please not right now.’ It just doesn’t work that way. It is coming. Get prepared, you have a few weeks. It is that simple.
Caleb BarlowPresident and CEO, CynergisTek

Healthcare systems and even the U.S. Department of Health and Human Services are seeing phishing and other similar attacks right now, but Barlow warns that healthcare CIOs and CISOs need to prepare for the more insidious healthcare cyberattacks that are coming, including ransomware.

“We have to realize that these attackers are highly motivated,” Barlow said. “Many of them, particularly with things like ransomware, are nation-state actors. These are how nation-states fund their activities. There is not going to be a plea to bad guys of, ‘Please not right now.’ It just doesn’t work that way. It is coming. Get prepared, you have a few weeks. It is that simple.”

Cyberthreats seen on the front lines

Anahi Santiago, CISO at the Delaware-based ChristianaCare health system, said there has been a rapid increase in social engineering attacks — including phishing, where bad actors appear as a trusted source and trick healthcare employees into revealing their credentials — that are testing healthcare systems during the coronavirus crisis.

Anahi SantiagoAnahi Santiago

Although the ChristianaCare health system has security tools to prevent phishing attacks on the organization, Santiago said home computers may not have the same protections. Additionally, Santiago said threat actors are setting up websites using legitimate coronavirus outbreak global maps to trick people into visiting those sites and, unbeknownst to them, downloading malware. While the healthcare system’s security tools block malicious websites, clinicians may not have the same types of protection at home.

CynergisTek’s Barlow said the “threat landscape has increased dramatically,” as regulations have been relaxed to enable physicians to work and treat patients remotely. That increased threat landscape includes a physician’s home network, which gives bad actors more opportunity to gain access to a healthcare institution.

As cyberattackers capitalize on this opportunity, Barlow said it’s important for health systems’ security teams to mobilize and for healthcare CIOs and CISOs to have a plan in place in case their healthcare system is breached.

Santiago echoed Barlow’s call on security teams, saying awareness and ensuring the cybersecurity posture remains intact are key to preventing these kinds of attacks.

“We have been working very closely with our external affairs folks to communicate to the organization so that our caregivers have awareness, not only around potential phishing and social engineering attacks that might come through the organization, but also to be aware at home,” she said. “We’re doing a lot of enablement for the organization, but also making sure that we’re thinking about our caregivers and their families and making sure we’re giving them the tools to be able to go home and continue to protect themselves.”

Aaron MiriAaron Miri

Aaron Miri, CIO at the University of Texas at Austin Dell Medical School and UT Health Austin, said he has heard of academic medical institutions and healthcare systems being under constant attack and is remaining vigilant.

“During any situation, even if it’s a Friday afternoon at 5 o’clock, you can expect to see bad actors try to capitalize,” he said. “It is an unfortunate way of the world and it’s reality, so we are always keeping watch.”

Preparing for cyberattacks

Barlow said there are a few steps healthcare security teams can take to make sure providers working at home are doing so securely.

First, he said it’s key to make sure clinicians have proper virtual private networks (VPNs) in place and that they’re set up properly. A VPN creates a safe connection between a device that could be on a less secure network and the healthcare system network.

Second, he said security teams should make sure those computers have proper protection, often referred to as endpoint security. Endpoint security ensures devices meet certain security criteria before being allowed to connect to a hospital’s network.

The next step is getting a plan in place so that when a healthcare system is breached or hit with ransomware, it will know how to respond, he said. The plan should include how to manage a breach in light of the pandemic, when leaders of the organization are likely working from home.

“If you are hit with ransomware, how are you going to process through that, how are you going to do that when you can’t get everybody in the room … how are you going to make decisions, who are you going to work with,” he said. “Get those plans up to date.”

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Emsisoft, Coveware offer free ransomware services to hospitals

As the coronavirus pandemic continues to overwhelm healthcare and medical facilities, another complication has surfaced: the possibility of a ransomware attack, which have been shown to spike during the spring and summer months, according to antimalware vendor Emsisoft.

In anticipation of such attacks, Emsisoft and incident response company Coveware partnered for an initiative to give healthcare providers access to both companies’ complete range of ransomware response services at no cost for the duration of the crisis. The aim is to get impacted providers operational again in the shortest possible time so that patient care is minimally disrupted, Emsisoft threat analyst Brett Callow said.

In the event of a ransomware attack, Emsisoft and Coveware will provide services to hospitals and medical facilities that include technical analysis of the ransomware; the development of a decryption tool, if possible; and “as a last resort, ransom negotiation, including transaction handling and recovery assistance including replacement of the decryption tool supplied by the criminals with a custom tool that will recover data faster and with less chance of data loss,” according to a blog post from Emsisoft.

Bill Siegel, CEO of Coveware, cautioned that a ransomware attack on a healthcare organization will still have devastating consequences, regardless of how Emsisoft and Coveware can mitigate it. “Even with our help, it will likely result in unnecessary causalities because of the disruption,” Siegel said.

Bracing for ransomware attacks

Emsisoft’s blog said, “it is likely that there will be an increase in the number of healthcare providers impacted by ransomware in the coming months and unfortunately this increase may coincide with the peak of the COVID-19 outbreak. Further, the spikes may be more pronounced than in previous years due to security weaknesses resulting from hastily introduced work-from-home arrangements, personal device usage and staffing shortages.”

A ransomware attack could hinder response efforts, communications and treatments during the pandemic.

Even prior to the pandemic, healthcare facilities were a common target of ransomware attacks. At least 764 healthcare providers were impacted by ransomware in 2019, according to the Emsisoft report, titled “The State of Ransomware in the U.S.: Report and Statistics 2019.”

However, two ransomware gangs, Maze and DoppelPaymer, announced Wednesday they would cease ransomware attacks on medical and healthcare facilities during the COVID-19 pandemic. Despite these promises, the problem persists, according to Callow.

“I saw a medical research company in the U.K. was attacked a couple days ago by a group who steals data and threatens to release it if you don’t pay,” Callow said, referencing the Maze group.

Siegel said he hopes the promise made by ransomware gangs is genuine.

“It will be interesting to see if Defray/777 ransomware affiliates adhere, as that variant almost exclusively targeted healthcare providers prior to the pandemic,” Siegel said.

Since the announcement on Wednesday, no one has yet to take up the free offer, and both Callow and Siegel said they hope no one will need to.

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Maze ransomware gang pledges to stop attacking hospitals

The notorious Maze ransomware gang announced Wednesday that it will not attack any healthcare organizations during the COVID-19 pandemic.

The pandemic has put a strain hospitals and public health agencies in recent weeks as governments across the globe struggle to contain the spread of COVID-19, also known as the new coronavirus. Some security vendors have expressed concern that coronavirus-related threats could soon include ransomware attacks, which would have a crippling effect on healthcare and government organizations working on treatment and containment of the virus.

But at least one cybercrime outfit is pledging to refrain from such attacks, at least on healthcare organizations. The Maze ransomware gang, which last year began “shaming” victims by exfiltrating and publishing organizations’ sensitive data, promised to ” stop all activity versus all kinds of medical organizations until the stabilization of the situation with virus,” according to an announcement on its website.

BleepingComputer, which first reported the announcement, also contacted other ransomware operators about stopping attacks on healthcare and medical organizations during the pandemic. The DoppelPaymer gang also pledged to stop such attacks, though other ransomware groups such as Ryuk and Sodinokibi/REvil did not respond to Bleeping Computer’s queries.

The Maze gang’s pledge, however, says nothing about attacks on city, state or local governments or public health agencies. The Maze gang also said it will “help commercial organizations as much as possible” during the pandemic by offering “exclusive discounts” on ransoms to both current and future ransomware victims; the cybercriminals said they will provide decryptors and deleted any data published on its website.

A screenshot of the Maze ransomware gang's announcement that it will not attack healthcare organizations during the coronavirus pandemic.
A screenshot of the Maze ransomware gang’s announcement that it will not attack healthcare organizations during the coronavirus pandemic.

Despite the promises of the DoppelPaymer and Maze ransomware gangs, it’s unclear how much control they have over what organizations are attacked. Many outfits use a ransomware-as-a-service model where they develop the malicious code and then sell it to other cybercriminals, which are often called affiliates.

These affiliates then conduct the actual intrusions, data exfiltration and ransomware deployment and pay the authors. Many ransomware incidents are initiated through phishing emails and brute-force attacks on remote desktop protocol instances; threat researchers have said it’s likely that ransomware actors aren’t specifically targeting organizations by name or industry and are merely capitalizing on the most vulnerable networks.

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Microsoft for Healthcare: Empowering our customers and partners to provide better experiences, insights and care – The Official Microsoft Blog

At Microsoft, our goal within healthcare is to empower people and organizations to address the complex challenges facing the healthcare industry today. We help do this by co-innovating and collaborating with our customers and partners as a trusted technology provider. Today, we’re excited to share progress on the latest innovations from Microsoft aimed at helping address the most prevalent and persistent health and business challenges:

  • Empower care teams with Microsoft 365: Available in the coming weeks, the new Bookings app in Microsoft Teams will empower care teams to schedule, manage and conduct virtual visits with remote patients via video conference. Also coming soon, clinicians will be able to target Teams messages to recipients based on the shift they are working. Finally, healthcare customers can support their security and compliance requirements with the HIPAA/HITECH assessment in Microsoft Compliance Score.
  • Protect health information with Azure Sphere: Microsoft’s integrated security solution for IoT (Internet of Things) devices and equipment – is now widely available for the development and deployment of secure, connected devices. Azure Sphere helps securely personalize patient experiences with connected devices and solutions. And, to make it easier for healthcare leaders to develop their own IoT strategies, today we’re launching a new IoT Signals report focused on the healthcare industry that provides an industry pulse on the state of IoT adoption and helpful insights for IoT strategies. Learn more about Microsoft’s IoT offerings for healthcare here.
  • Enable personalized virtual care with Microsoft Healthcare Bot: Today, we’re pleased to announce that Microsoft Healthcare Bot, our HITRUST-certified platform for creating virtual health assistants, is enriching its healthcare intelligence with new built-in templates for healthcare-specific use cases, and expanding its integrated medical content options. With the addition of Infermedica, a cutting-edge triage engine based on advanced artificial intelligence (AI) that enables symptom checking in 17 languages Healthcare Bot is empowering providers to offer global access to care.
  • Reimagine healthcare using new data platform innovations: With the 2019 release of Azure API for FHIR, Microsoft became the first cloud provider with a fully managed, enterprise-grade service for health data in the Fast Healthcare Interoperability Resources (FHIR) format. We’re excited to expand those offerings with several new innovations around connecting, converting and transforming data. The first is Power BI FHIR Connector, which makes it simple and easy to bring FHIR data into Power BI for analytics and insights. The second, IoMT (Internet of Medical Things) FHIR Connector, is now available as open source software (OSS) and allows for seamless ingestion, normalization and transformation of Protected Health Information data from health devices into FHIR. Another new open source project, FHIR Converter, provides an easy way to convert healthcare data from legacy formats (i.e., HL7v2) into FHIR. And lastly, FHIR Tools for Anonymization, is now offered via OSS and enables anonymization and pseudonymization of data in the FHIR format. Including capabilities for redaction and date shifting in accordance with the HIPAA privacy rule.

Frictionless exchange of health information in FHIR makes it easier for researchers and clinicians to collaborate, innovate and improve patient care. As we move forward working with our customers and partners and others across the health ecosystem, Microsoft is committed to enabling and improving interoperability and required standards to make it easier for patients to manage their healthcare and control their information. At the same time, trust, privacy and compliance are a top priority – making sure Protected Health Information (PHI) remains under control and custodianship of healthcare providers and their patients.

We’ve seen a growing number of healthcare organizations not only deploy new technologies, but also begin to develop their own digital capabilities and solutions that use data and AI to transform and innovate healthcare and life sciences in profoundly positive ways. Over the past year, together with our customers and partners, we’ve announced new strategic partnerships aimed at empowering this transformation.

For example, to enable caregivers to focus more on patients by dramatically reducing the burden of documenting doctor-patient visits, Nuance has released Nuance Dragon Ambient eXperience (DAX). This ambient clinical intelligence technologies (ACI) is enriched by AI and cloud capabilities from Microsoft, including the ambient intelligence technology, EmpowerMD, which is coming to market as part of Nuance’s DAX solution. The solution aims to transform the exam room by deploying ACI to capture, with patient consent, interactions between clinicians and patients so that clinical documentation writes itself.

Among health systems, Providence St. Joseph Health is using Microsoft’s cloud, AI, productivity and collaboration technologies to deploy next-generation healthcare solutions while empowering their employees. NHS Calderdale is enabling patients and their providers to hold appointments virtually via Microsoft Teams for routine and follow-up visits, which helps lower costs while maintaining the quality of care. The U.S. Veterans Affairs Department is embracing mixed reality by working with technology providers Medivis, Microsoft and Verizon to roll out its first 5G-enabled hospital. And specifically for health consumers, Walgreens Boots Alliance will harness the power of our cloud, AI and productivity technologies to empower care teams and deliver new retail solutions to make healthcare delivery more personal, affordable and accessible.

Major payor, pharmaceutical and health technology platform companies are also transforming healthcare in collaboration with us. Humana will develop predictive solutions for personalized and secure patient support, and by using Azure, Azure AI and Microsoft 365, they’ll also equip home healthcare workers with real-time access to information and voice technology to better understand key factors that influence patient health. In pharmaceuticals, Novartis will bring Microsoft AI capabilities together with its deep expertise in life sciences to address specific challenges that make the process of discovering, developing and delivering new medicines so costly and time-consuming.

We’re pleased to showcase how together with our customers and partners, we’re working to bring healthcare solutions to life and positively impact the health ecosystem.

To keep up to date with the latest announcements visit the Microsoft Health News Room.

About the authors:
As Corporate Vice President of Health Technology and Alliances, Dr. Greg Moore leads the dedicated research and development collaborations with our strategic partners, to deliver next-generation technologies and experiences for healthcare.

Vice President and Chief Medical Officer Dr. David Rhew recently joined Microsoft’s Worldwide Commercial Business Healthcare leadership team and provides executive-level support, engaging in business opportunities with our customers and partners.

As Corporate Vice President of Healthcare, Peter Lee leads the Microsoft organization that works on technologies for better and more efficient healthcare, with a special focus on AI and cloud computing.

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Author: Microsoft News Center

AI, Azure and the future of healthcare with Dr. Peter Lee – Microsoft Research

headshot of Peter Lee for the Microsoft Research Podcast

Episode 109 | March 4, 2020

Over the past decade, the healthcare industry has undergone a series of technological changes in an effort to modernize it and bring it into the digital world, but the call for innovation persists. One person answering that call is Dr. Peter Lee, Corporate Vice President of Microsoft Healthcare, a new organization dedicated to accelerating healthcare innovation through AI and cloud computing.

Today, Dr. Lee talks about how MSR’s advances in healthcare technology are impacting the business of Microsoft Healthcare. He also explains how promising innovations like precision medicine, conversational chatbots and Azure’s API for data interoperability may make healthcare better and more efficient in the future.

Related:


Transcript

Peter Lee: In tech industry terms, you know, if the last decade was about digitizing healthcare, the next decade is about making all that digital data good for something, and that good for something is going to depend on data flowing where it needs to flow at the right time.

Host: You’re listening to the Microsoft Research Podcast, a show that brings you closer to the cutting-edge of technology research and the scientists behind it. I’m your host, Gretchen Huizinga.

Host: Over the past decade, the healthcare industry has undergone a series of technological changes in an effort to modernize it and bring it into the digital world, but the call for innovation persists. One person answering that call is Dr. Peter Lee, Corporate Vice President of Microsoft Healthcare, a new organization dedicated to accelerating healthcare innovation through AI and cloud computing.

Today, Dr. Lee talks about how MSR’s advances in healthcare technology are impacting the business of Microsoft Healthcare. He also explains how promising innovations like precision medicine, conversational chatbots and Azure’s API for data interoperability may make healthcare better and more efficient in the future. That and much more on this episode of the Microsoft Research Podcast.

(music plays)

Host: Peter Lee, welcome to the podcast!

Peter Lee: Thank you. It’s great to be here.

Host: So you’re a Microsoft Corporate Vice President and head of a relatively new organization here called Microsoft Healthcare. Let’s start by situating that within the larger scope of Microsoft Research and Microsoft writ large. What is Microsoft Healthcare, why was it formed, and what do you hope to do with it?

Peter Lee: It’s such a great question because when, we were first asked to take this on, it was confusing to me! Healthcare is such a gigantic business in Microsoft. You know, the number that really gets me is, Microsoft has commercial contracts with almost 169,000 healthcare organizations around the world.

Host: Wow.

Peter Lee: I mean, it’s just massive. Basically, anything from a one-nurse clinic in Nairobi, Kenya, to Kaiser Permanente or United Healthcare, and everything in-between. And so it was confusing to try to understand, what is Satya Nadella thinking to ask a “research-y” organization to take this on? But, you know, the future of healthcare is so vibrant and dynamic right now, and is so dependent on AI, on Cloud computing, big data, I think he was really wanting us to think about that future.

Host: Let’s situate you.

Peter Lee: Okay.

Host: You cross a lot of boundaries from pure to applied research, computer science to medicine. You’ve been head of Carnegie Mellon University’s computer science department, but you were also an office director at DARPA, which is the poster child for applied research. You’re an ACM fellow and on the board of directors of the Allen Institute for AI, but you’re also a member of the National Academy of Medicine, fairly newly minted as I understand?

Peter Lee: Right, just this year.

Host: And on the board of Kaiser Permanente’s School of Medicine. So, I’d ask you what gets you up in the morning, but it seems like you never go to bed So instead, describe what you do for a living, Peter! How you choose what hat to wear in the morning and what’s a typical day in your life look like?

Peter Lee: Well, you know, this was never my plan. I just love research, and thinking hard about problems, being around other smart people and thinking hard about problems, getting real depth of understanding. That’s what gets me up. But I think the world today, what’s so exciting about it for anyone with the research gene, is that research, in a variety of areas, has become so important to practical, everyday life. It’s become important to Microsoft’s business. Not just Microsoft, but all of our competitors. And so I just feel like I’m in a lucky position, as well as a lot of my colleagues, I don’t think any of us started with that idea. We just wanted to do research and now we’re finding ourselves sort of in the middle of things.

Host: Right. Well, talk a little bit more about computer science and medicine. How have you moved from one to the other, and how do you kind of envision yourself in this arena?

Peter Lee: Well, my joke here is, these were changes that, actually, Satya Nadella forced me to make! And it’s a little bit of a joke because I was actually honored that he would think of me this way, but it was also painful because I was in a comfort zone just doing my own research, leading research teams, and then, you know, Satya Nadella becomes the CEO, Harry Shum comes on board to drive innovation, and I get asked to think about new ways to take research ideas and get them out into the world. And then, three years after that, I get asked to think about the same thing for healthcare. And each one of those, to my mind, are examples of this concept that Satya Nadella likes to talk about, “growth mindset.” I joke that growth mindset is actually a euphemism because each time you’re asked to make these changes, you just get this feeling of dread. You might have a minute where you’re feeling honored that someone would ask you something, but then…

Host: Oh, no! I’ve got to do it now!

Peter Lee: …and boy, I was, you know, on a roll in what I was doing before, and you do spend some time feeling sorry for yourself… but when you work through those moments, you find that you do have those periods in your life where you grow a lot. And my immersion with so many great people in healthcare over the last three or four years has been one of those big growth periods. And to be recognized, then, let’s say, by the National Academies is sort of validation of that.

Host: All right, so rewind just a little bit and talk about that space you were in just before you got into the healthcare situation. You were doing Microsoft Research. Where, on the spectrum from pure, like your Carnegie Mellon roots, to applied, like your DARPA roots, did that land? There’s an organization called NeXT here I think, yeah?

Peter Lee: That’s right. You know, when I was in academia, academia really knows how to do research.

Host: Yeah.

Peter Lee: And they really put the creatives, the graduate students and the faculty, at the top of the pyramid, socially, in the university. It’s just a great setup. And it’s organized into departments, which are each named after a research area or a discipline and within the departments there are groups of people organized by sub-discipline or area, and so it’s an organizing principle that’s tried and true. When I went to DARPA, it was completely different. The departments aren’t organized by research area, they’re organized by mission, some easily assessable goal or objective. You can always answer the question, have we accomplished it yet or not?

Host: Right.

Peter Lee: And so research at DARPA is organized around those missions and that was a big learning experience for me. It’s not like saying we’re going to do computer vision research. We’ll be doing that for the next fifty years. It’s, can we eliminate the language barrier for all internet-connected people? That’s a mission. You can answer the question, you know, how close are we?

Host: Right.

Peter Lee: And so the mix between those two modes of research, from academia to DARPA, is something that I took with me when I joined Microsoft Research and, you know, Microsoft Research has some mix, but I thought the balance could be slightly different. And then, when Satya Nadella became the CEO and Harry Shum took over our division, they challenged me to go bigger on that idea and that’s how NeXT started. NeXT tried to organize itself by missions and it tried to take passionate people and brilliant ideas and grow them into new lines of business, new engineering capabilities for Microsoft, and along the way, create new CVPs and TFs for our company. There’s a tension here because one of the things that’s so important for great research is stability. And so when you organize things like you do in academia, and in large parts of Microsoft Research, you get that stability by having groups of people devoted to an area. We have, for example, say, computer networking research groups that are best in the world.

Host: Right.

Peter Lee: And they’ve been stable for a long time and, you know, they just create more and more knowledge and depth, and that stability is just so important. You feel like you can take big risks when you have that stability. When you are mission-oriented, like in NeXT, these missions are coming and going all the time. So that has to be managed carefully, but the other benefit of that, management-wise, is more people get a chance to step up and express their leadership. So it’s not that either model is superior to the other, but it’s good to have both. And when you’re in a company with all the resources that Microsoft has, we really should have both.

Host: Well, let’s zoom out and talk, somewhat generally, about the promise of AI because that’s where we’re going to land on some of the more specific things we’ll talk about in a bit, but Microsoft has several initiatives under a larger umbrella called AI for Good and the aim is to bring the power of AI to societal-scale problems in things like agriculture, broadband accessibility, education, environment and, of course, medicine. So AI for Health is one of these initiatives, but it’s not the same thing as Microsoft Healthcare, right?

Peter Lee: Well, the whole AI for Good program is so exciting and I’m just so proud to be in a company that makes this kind of commitment. You can think of it as a philanthropic grants program and it is, in fact, in all of these areas, providing funding and technical support to really worthy teams, passionate people, really trying to bring AI to bear for the greater good.

Host: Mm-hmm.

Peter Lee: But it’s also the case that we devote our own research resources to these things. So it’s not just giving out grants, but it’s actually getting into collaborations. What’s interesting about AI for Health is that it’s the first pillar in the AI for Good program that actually overlaps with a business at Microsoft and that’s Microsoft Healthcare. One way that I think about it is, it’s an outlet for researchers to think about, what could AI do to advance medicine? When you talk to a lot of researchers in computer science departments, or across Microsoft research labs, increasingly you’ll see more and more of them getting interested in healthcare and medicine and the first things that they tend to think about, if they’re new to the field, are diagnostic and therapeutic applications. Can we come up with something that will detect ovarian cancer earlier? Can we come up with new imaging techniques that will help radiologists do a better job? Those sorts of diagnostic and therapeutic applications, I think, are incredibly important for the world, but they are not Microsoft businesses. So the AI for Health program can provide an outlet for those types of research passions. And then there are also, as a secondary element, four billion people on this planet today that have no reasonable access to healthcare. AI and technology have to be part of the solution to creating that more equitable access and so that’s another element that, again, doesn’t directly touch Microsoft’s business today in Microsoft Healthcare, but is so important we have a lot to offer so AI for Health is just, I think, an incredibly visionary and wonderful program for that.

Host: Well, let’s zoom back out… um, no, let’s zoom back in. I’ve lost track of the camera. I don’t know where it is! Let’s talk about the idea of precision medicine, or precision healthcare, and the dream of improving those diagnostic and therapeutic interventions with AI. Tell us what precision medicine is and how that plays out and how are the two rather culturally diverse fields of computer science and medicine coming together to solve for X here?

Peter Lee: Yeah, I think one of the things that is sometimes underappreciated is, over the past ten to twenty years, there’s been a massive digitization of healthcare and medicine. After the 2008 economic collapse, in 2009, there was the ARA… there was a piece of legislation attached to that called the HITECH Act, and HITECH actually required healthcare organizations to digitize health records. And so for the past ten years, we’ve gone from something like 15% of health records being in digital form, to today, now over 98% of health records are in digital form. And along with that, medical devices that measure you have gone digital, our ability to sequence and analyze your genome, your proteome, have gone digital and now the question is, what can we do with all the digital information? And on top of that, we have social information.

Host: Yeah.

Peter Lee: People are carrying mobile devices, people talk to computers at home, people go to their Walgreens to get their flu shots.

Host: Yeah.

Peter Lee: And all of this is in digital form and so the question is, can we take all of that digital data and use it to provide highly personalized and precisely targeted diagnostics and therapeutics to people.

Host: Mm-hmm.

Peter Lee: Can we get a holistic, kind of, 360-degree view of you, specifically, of what’s going on with you right now, and what might go on over the next several years, and target your wellness? Can we advance from sick care, which is really what we have today…

Host: Right.

Peter Lee: …to healthcare.

Host: When a big tech company like Microsoft throws its hat in the healthcare ring and publicly says that it has the goal of “transforming how healthcare is experienced and delivered,” I immediately think of the word disruption, but you’ve said healthcare isn’t something you disrupt. What do you mean by that, and if disruption isn’t the goal, what is?

Peter Lee: Right. You know, healthcare is not a normal business. Worldwide, it’s actually a $7.5 trillion dollar business. And for Microsoft, it’s incredibly important because, as we were discussing, it’s gone digital, and increasingly, that digital data, and the services and AI and computation to make good use of the data, is moving to the cloud. So it has to be something that we pay very close attention to and we have a business priority to support that.

Host: Right.

Peter Lee: But, you know, it’s not a normal business in many, many different senses. As a patient, people don’t shop, at least not on price, for their healthcare. They might go on a website to look at ratings of primary care physicians, but certainly, if you’re in a car accident, you’re unconscious. You’re not shopping.

Host: No.

Peter Lee: You’re just looking for the best possible care. And similarly, there’s a massive shift for healthcare providers away from what’s called fee-for-service, and toward something called value-based care where doctors and clinics are being reimbursed based on the quality of the outcomes. What you’re trying to do is create success for those people and organizations that, let’s face it, they’ve devoted their lives to helping people be healthier. And so it really is almost the purest expression of Microsoft’s mission of empowerment. It’s not, how do we create a disruption that allows us to make more money, but instead, you know, how do we empower people and organizations to deliver better – and receive better – healthcare? Today in the US, a primary care doctor spends almost twice as much time entering clinical documentation as they do actually taking care of patients. Some of the doctors we work with here at Microsoft call this “pajama time,” because you spend your day working with patients and then, at home, when you crawl into bed, you have to finish up your documentation. That’s a big source of burn out.

Host: Oh, yeah.

Peter Lee: And so, what can we do, using speech recognition technologies, natural language processing, diarization, to enable that clinical note-taking to be dramatically reduced? You know, how would that help doctors pay more attention to their patients? There is something called revenue-cycle management, and it’s sort of sometimes viewed as a kind of evil way to maximize revenues in a clinic or hospital system, but it is also a place where you can really try to eliminate waste. Today, in the US market, most estimates say that about a trillion dollars every year is just gone to waste in the US healthcare system. And so these are sort of data analysis problems, in this highly complex system, that really require the kind of AI and machine learning that we develop.

Host: And those are the kinds of disruptions we’d like to see, right?

Peter Lee: That’s right. Yeah.

Host: We’ll call them successes, as you did.

Peter Lee: Well, and they are disruptions though, they’re disruptions that help today’s working doctors and nurses. They help today’s hospital administrators.

(music plays)

Host: Let’s talk about several innovations that you’ve actually made to help support the healthcare industry’s transformation. Last year – year ago – at the HIMSS conference, you talked about tools that would improve communication, the healthcare experience and interoperability and data sharing in the cloud. Tell us about these innovations. What did you envision then, and now, a year later, how are they working out?

Peter Lee: Yeah. Maybe the one I like to start with is about interoperability. I sometimes have joked that it’s the least sexy topic, but it’s the one that is, I think, the most important to us. In tech industry terms, you know, if the last decade was about digitizing healthcare, the next decade is about making all that digital data good for something and that good for something is going to depend on data flowing where it needs to flow…

Host: Right.

Peter Lee: …at the right time. And doing that in a way that protects people’s privacy because health data is very, very personal. And so a fundamental issue there is interoperability. Today, while we have all this digital data, it’s really locked into thousands of different incompatible data formats. It doesn’t get exposed through modern APIs or microservices. It’s oftentimes siloed for business reasons, and so unlocking that is important. One way that we look at it here at Microsoft is, we are seeing a rising tidal wave of healthcare organizations starting to move to the cloud. Probably ten years from now, almost all healthcare organizations will be in the cloud. And so, with that historic shift that will happen only once, ever, in human history, what can we do today to ensure that we end up in a better place ten years from now than we are now? And interoperability is one of the keys there. And that’s something that’s been recognized by multiple governments. The US government, through the Centers for Medicare and Medicaid Services, has proposed new regulations that require the use of specific interoperable data standards and API frameworks. And I’m very proud that Microsoft has participated in helping endorse and guide the specific technical choices in those new rules.

Host: So what is the API that Microsoft has?

Peter Lee: So the data standard that we’ve put a lot of effort behind is something called FHIR. F-H-I-R, Fast Healthcare Interoperability Resources. And for anyone that’s used to working in the web, you can look at FHIR and you’ll see something very familiar. It’s a modern data standard, it’s extensible, because medical science is advancing all the time, and it’s highly susceptible to analysis through machine learning.

Host: Okay.

Peter Lee: And so it’s utterly modern and standardized, and I think FHIR can be a lingua franca for all healthcare data everywhere. And so, for Microsoft, we’ve integrated FHIR as a first-class data type in our cloud, in Azure.

Host: Oh, okay.

Peter Lee: We’ve enabled FHIR in Office. So the Teams application, for example, it can connect to health data for doctors and nurses. And there’s integration going on into Dynamics. And so it’s a way to convert everything that we do here at Microsoft into great healthcare-capable tools. And once you have FHIR in the cloud, then you also, suddenly, unlock all of the AI tools that we have to just enable all that precision medicine down the line.

Host: That’s such a Biblical reference right then! The cloud and the FHIR.

Peter Lee: You know, there are – there’s an endless supply of bad puns around FHIR. So thank you for contributing to that.

Host: Well, it makes me think about the Fyre Festival, which was spelt F-Y-R-E, which was just the biggest debacle in festival history

Peter Lee: I should say, by the way, another thing that everyone connected to Microsoft should be proud of is, we have really been one of the chief architects for this new future. One of the most important people in the FHIR development community is Josh Mandel, who works with us here at Microsoft Healthcare, and he has the title Chief Architect, but it’s not Chief Architect for Microsoft, it’s Chief Architect for the cloud.

Host: Oh, my gosh.

Peter Lee: So he spends time talking to the folks at Google, at AWS, at Salesforce and so on.

Host: Right.

Peter Lee: Because we’re trying to bring the entire cloud ecosystem along to this new future.

Host: Tell me a little bit about what role bots might play in this arena?

Peter Lee: Bots are really interesting because, how many listeners have received a lab test result and have no idea what it means? How many people have received some weird piece of paper or bill in the mail from their insurance company? It’s not just medical advice, you know, where you have a scratch in your throat and you’re worried about what you should do. That’s important too, but the idea of bots in healthcare really span all these other things. One of the most touching, in a project led by Hadas Bitran and her team, has been in the area of clinical trials. So there’s a website called clinicaltrials.gov and it contains a registry describing every registered clinical trial going on. So now, if you are desperate for more experimental care, or you’re a doctor treating someone and you’re desperate for this, you know, how do you find, out of thousands of documents, and they’re complicated…

Host: Right.

Peter Lee: …technical, medical, science things.

Host: Jargon-y.

Peter Lee: Yeah, and it’s difficult. If you go to clinicaltrials.gov and type into the search box ‘breast cancer’ you get hundreds of results. So the cool project that Hadas and her team led was to use machine reading from Microsoft Research out of Hoifung Poon’s team, to read all of those clinical trials documents and create a knowledge graph and use that knowledge graph then to drive a conversational chatbot so that you can engage in a conversation. So you can say, you know, “I have breast cancer. I’m looking for a clinical trial,” and the chatbot will start to ask you questions in order to narrow down, eventually, to the one or two or three clinical trials that might be just right for you. And so this is something that we just think has a lot of potential.

Host: Yeah.

Peter Lee: And business-wise, there are more mundane, but also important things. Just call centers. Boy, those nurses are busy. What would happen if we had a bot that would triage and tee up some of those things and really give superpowers to those call center nurses. And so it’s that type of thing that I think is very exciting about conversational tech in general. And of course, Microsoft Research and NeXT should be really proud of really pioneering a lot of this bot technology.

Host: Right. So if I employed a bot to narrow down the clinical trials, could I get myself into one? Is that what you’re explaining here?

Peter Lee: Yeah, in fact, the idea here is that this would help, tremendously, the connection between perspective patients and clinical trials. It’s so important because pharmaceutical companies, in clinics that are setting up clinical trials, more than 50% of them fail to recruit enough participants. They just never get off the ground because they don’t get enough. The recruitment problem is so difficult.

Host: Wow.

Peter Lee: And so this is something that can really help on both ends.

Host: I didn’t even think about it from the other angle. Like, getting people in. I always just assumed, well, a clinical trial, no biggie.

Peter Lee: It’s such a sad thing that most clinical trials fail. And fail because of the recruitment problem.

Host: Huh. Well, let’s talk a little bit more about some of the really interesting projects that are going on across the labs here at Microsoft Research. So what are some of the projects and who are some of the people that are working to improve healthcare in technology research?

Peter Lee: Yeah. I think pretty much every MSR lab is doing interesting things. There’s some wonderful work going on in the Cambridge UK lab, in Chris Bishop’s lab there, in a group being led by Aditya Nori. One of the things there has been a set of projects in collaboration with Novartis really looking at new ideas about AI-powered molecule design for cellular therapies, as well as very precise dosing of therapies for things like macular degeneration and so these are, sort of, bringing the very best machine learning and AI researchers shoulder-to-shoulder with the best researchers and scientists at Novartis to really kind of innovate and invent the future. In the MSR India lab, Sriram Rajamani’s team, they’ve been standing up a really impressive set of technologies and projects that have to do with global access to healthcare and this is something that I think is just incredibly, incredibly important. You know, we really could enable, through more intelligent medical devices for example, much less well-trained technicians and clinicians to be able to deliver healthcare at a distance. The other thing that is very exciting to me there is just looking at data. You know, how do we normalize data from lots of different sources?

Host: Right.

Peter Lee: And then MSR Asia in Beijing, they’ve increasingly been redirecting some of the amazing advances that that lab is famous for in computer vision to the medical imaging space. And there are just amazing possibilities in taking images that might not be high resolution enough for a precise diagnosis and using AI to, kind of, magically improve the resolution. And so just across board, you go from, kind of, lab to lab you just see some really inspiring work going on.

Host: Yeah, some of the researchers have been on the podcast. Antonio Criminisi with InnerEye, umm…  haven’t had Ethan Jackson from Premonition yet

Peter Lee: No, Premonition… Well, Antonio Criminisi and the work that he led on InnerEye, you know, we actually went all the way to an FDA 510(k) approval on the tumor segmentations…

Host: Wow.

Peter Lee: …and the components of that now are going into our cloud. Really amazing stuff.

Host: Yeah.

Peter Lee: And then Premonition, this is one of these things that is, in the age of coronavirus…

Host: Right?

Peter Lee: …is very topical.

Host: I was just going to refer to that, but I thought maybe I shouldn’t…

Peter Lee: The thing that is so important is, we talked of precision medicine before…

Host: Yeah.

Peter Lee: …but there is also an emerging science of precision population health. And in fact, the National Academy of Medicine just recently codified that as an official part of medical research and it’s bringing some of the same sort of precision medicine ideas, but to population health applications and studies. And so when you look at Premonition, and the ability to look at a whole community and get a genetically precise diagnosis of what is going on in that community, it is something that could really be a game-changer, especially in an era where we are seeing more challenging infectious disease outbreaks.

Host: I think a lot of people would say, can we speed that one up a little? I want you to talk for a minute about the broader tech and healthcare ecosystem and what it takes to be a leader, both thought and otherwise, in the field. So you’ve noted that we’re in the middle of a big transformation that’s only going to happen once in history and because of that, you have a question that you ask yourself and everyone who reports to you. So what’s the question that you ask, and how does the answer impact Microsoft’s position as a leader?

Peter Lee: Right. You know, healthcare, in most parts of the world, is really facing some big challenges. It’s at a financial breaking point in almost all developed countries. The spread of the latest access to good medical practice has been slowing in the developing world and as you, kind of, look at, you know, how to break out of these cycles, increasingly, people turn to technology. And the kind of shining beacon of hope is this mountain of digital data that’s being produced every single day and so how can we convert that into what’s called the triple aim of better outcomes, lower costs and better experiences? So then, when you come to Microsoft, you have to wonder, well, if we’re going to try to make a contribution, how do you do it? When Satya Nadella asked us to take this on, we told ourselves a joke that he was throwing us into the middle of the Pacific Ocean and asking us to find land, because it’s such a big complex space, you know, where do you go? And, we had more jokes about this because you start swimming for a while and you start meeting lots of other people who are just as lost and you actually feel a little ashamed to feel good about seeing other people drowning. But it fundamentally it doesn’t help you to figure out what to work on, and so we started to ask ourselves the question, if Microsoft were to disappear today, in what ways would healthcare be harmed or held back tomorrow and into the future? If our hyperscale cloud were to disappear today, in what ways would that matter to healthcare? If all of the AI capabilities that we can deploy so cheaply on that cloud were to disappear, how would that matter? And then, since we’re coming out of Microsoft Research, if Microsoft Research were to disappear today, in what ways would that matter? And asking ourselves that question has sort of helped us focus on the areas where we think we have a right to play. And I think the wonderful thing about Microsoft today is, we have a business model that makes it easy to align those things to our business priorities. And so it’s really a special time right now.

(music plays)

Host: Well, this is – not to change tone really quickly – but this is the part of the podcast where I ask what could possibly go wrong? And since we’ve actually just used a drowning in the sea metaphor, it’s probably apropos… but when you bring nascent AI technologies, and I say nascent because most people have said, even though it’s been going on for a long time, we’re still in an infancy phase of these technologies. When you bring that to healthcare, and you’re literally dealing with lifeanddeath consequences, there’s not any margin for error. So… I realize that the answer to this question could be too long for the podcast, but I have to ask, what keeps you up at night, and how are you and your colleagues addressing potential negative consequences at the outset rather than waiting for the problems to appear downstream?

Peter Lee: That’s such an important question and it actually has multiple answers. Maybe the one that I think would be most obvious to the listeners of this podcast has to do with patient safety. Medical practice and medical science has really advanced on the idea of prospective studies and clinical validation, but that’s not how computer science, broadly speaking, works. In fact, when we’re talking about machine learning it’s really based on retrospective studies. You know, we take data that was generated in the past and we try to extract a model through machine learning from it. And what the world has learned, in the last few years, is that those retrospective studies don’t necessarily hold up very well, prospectively. And so that gap is very dangerous. It can lead to new therapies and diagnoses that go wrong in unpredictable ways, and there’s sort of an over-exuberance on both sides. As technologists, we’re pretty confident about what we do and we see lots of problems that we can solve, and the healthcare community is sometimes dazzled by all of the magical machine learning we do and so there can be over-confidence on both sides. That’s one thing that I worry about a lot because, you know, all over our field, not just all over Microsoft, but across all the other major tech companies and universities, there are just great technologists that are doing some wonderful things and are very well-intentioned, but aren’t necessarily validated in the right way. And so that’s something that, really, is worrisome. Going along with safety is privacy of people’s health data. And while I think most people would be glad to donate their health data for scientific progress, no one wants to be exploited. Exploited for money, or worse, you know, denied, for example, insurance.

Host: Right.

Peter Lee: And you know, these two things can really lead to outcomes, over the next decade, that could really damage our ability to make good progress in the future.

Host: So that said, we’re pretty good at identifying the problem. We may be able to start a good conversation, air quotes, on that, but this is, for me, like, what are you doing?

Peter Lee: Yeah.

Host: Because this is a huge thing, and

Peter Lee: I really think, for real progress and real transformation, that the foundations have to be right and those foundations do start with this idea of interoperability. So the good thing is that major governments, including the US government, are seeing this and they are making very definitive moves to foster this interoperable future. And so now, our role in that is to provide the technical guidance and technologies so that that’s done in the right way. And so everything that we at Microsoft are doing around interoperability, around security, around identity management, differential privacy, all of the work that came out of Microsoft Research in confidential computing…

Host: Yeah.

Peter Lee: …all of those things are likely to be part of this future. As important as confidential computing has been as a product of Microsoft Research, it’s going to be way, way more important in this healthcare future. And so it’s really up to us to make sure that regulators and lawmakers and clinicians are aware and smart about these things. And we can provide that technical guidance.

Host: What about the other companies that you mentioned? I mean, you’re not in this alone and it’s not just companies, it’s nations, and, I dare say, rogue actors, that are skilled in this arena. How do you get, sort of, agreement and compliance?

Peter Lee: I would say that Microsoft is in a good position because it has a clear business model. If someone is asking us, well what are you going to with our data? We have a very clear business model that says that we don’t monetize on your data.

Host: Right.

Peter Lee: But everyone is going to have to figure that out. Also, when you are getting into a new area like healthcare, every tech company is a big, complicated place with lots of stakeholders, lots of competing internal interests, lots of politics.

Host: Right.

Peter Lee: And so Microsoft, I think, is in a very good position that way too. We’re all operating as one Microsoft. But it’s so important that we all find ways to work together. One point of contact has been engineered by the White House in something called the Blue Button Developers Conference. So that’s where I’m literally holding hands with my counterparts at Google, at Salesforce, at Amazon, at IBM, making certain pledges there. And so the convening power of governments is pretty powerful.

Host: It’s story time. We’ve talked a little about your academic and professional life. Give us a short personal history. Where did it all start for Peter Lee and how did he end up where he is today?

Peter Lee: Oh, my.

Host: Has to be short.

Peter Lee: Well, let’s see, so uh, I’m Korean by heritage. I was born in Ohio, but Korean by heritage and my parents immigrated from Korea. My dad was a physics professor. He’s long retired now and my mother a chemistry professor.

Host: Wow.

Peter Lee: And she passed away some years ago. But I guess as an Asian kid growing up in a physical science household, I was destined to become a scientist myself. And in fact, they never said it out loud, but I think it was a disappointment to them when I went to college to study math! And then maybe an even the bigger disappointment when I went from math to computer science in grad school. Of course they’re very proud of me now.

Host: Of course! Where’d you go to school?

Peter Lee: I went to the University of Michigan. I was there as an undergrad and then I was planning to go work after that. I actually interviewed at a little, tiny company in the Pacific Northwest called Microsoft…

Host: Back then!

Peter Lee: … and …but I was wooed by my senior research advisor at Michigan to stay on for my PhD and so I stayed and then went from grad school right to Carnegie Mellon University as a professor.

Host: And then worked your way up to leading the department…

Peter Lee: Yeah. So I was there for twenty four years. They were wonderful years. Carnegie Mellon University is just a wonderful, wonderful place. And um..

Host: It’s almost like there’s a pipeline from Microsoft Research to Carnegie Mellon. Everyone is CMU this, CMU that!

Peter Lee: Well, I remember, as an assistant professor, when Rick Rashid came to my office to tell me that he was leaving to start this thing called Microsoft Research and I was really sad and shocked by that. Now here I am!

Host: Right. Well, tell us, um, if you can, one interesting thing about you that people might not know.

Peter Lee: I don’t know if people know this or not, but I have always had an interest in cars, in fast cars. I spent some time, when I was young, racing in something called shifter karts and then later in open wheel Formula Ford, and then, when I got my first real job at Carnegie Mellon, I had enough money that I spent quite a bit of it trying to get a sponsored ride with a semi-pro team. I never managed to make it. It’s hard to kind of split being an assistant professor and trying to follow that passion. You know, I don’t do that too much anymore. Once you are married and have a child, the annoyance factor gets a little high, but it’s something that I still really love and there’s a community of people, of course, at a place like Microsoft, that’s really passionate about cars as well.

Host: As we close, Peter, I’d like you to leave our listeners with some parting advice. Many of them are computer science people who may want to apply their skills in the world of healthcare, but are not sure how to get there from here. Where, in the vast sea of technology and healthcare research possibilities, should emerging researchers set their sights and where should they begin their swim?

Peter Lee: You know, I think it’s all about data and how to make something good out of data. And today, especially, you know, we are in that big sea of data silos. Every one of them has different formats, different rules, most of them don’t have modern APIs. And so things that can help evolve that system to a true ocean of data, I think anything to that extent will be great. And it is not just tinkering around with interfaces. It’s actually AI. To, say, normalize the schemas of two different data sets, intelligently, is something that we will need to do using the, kind of, latest machine learning, latest program synthesis, the kind of, latest data science techniques that we have on offer.

Host: Who do you want on your team in the coming years?

Peter Lee: The thing that I think I find so exciting about great researchers today is their intellectual flexibility to start looking at an idea and getting more and more depth of understanding, but then evolve as a person to understanding, you know, what is the value of this in the world, and understanding that that is a competitive world. And so, how willing are you to compete in that competitive marketplace to make the best stuff? And that evolution that we are seeing over and over again with people out of Microsoft Research is just incredibly exciting. When you see someone like a Galen Hunt or a Doug Burger or a Lili Cheng come out of Microsoft Research and then evolve into these world leaders in their respective fields, not just in research, but spanning research to really competing in a highly competitive marketplace, that is the future.

Host: Peter Lee, thank you for joining us on the podcast today. It’s been an absolute delight.

Peter Lee: Thank you for having me. It’s been fun.

(music plays)

To learn more about Dr. Peter Lee and how Microsoft is working to empower healthcare professionals around the world, visit Microsoft.com/research

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Author: Microsoft News Center

Pilots underscore Amazon healthcare strategy

Amazon’s initial moves into healthcare have analysts like Forrester’s Jeff Becker wondering what its larger game might be.

In the last two years, Amazon has increasingly set its sights on the healthcare industry as it makes acquisitions and tests healthcare products internally that could be pushed out to customers in an effort to solve larger issues, such as the lack of prescription price transparency and the high cost of healthcare.

The Amazon healthcare strategy includes acquiring online pharmacy PillPack and digital health technology startup Health Navigator. It also includes co-founding Haven. The initiative aims to use their combined resources and test new ways of lowering healthcare costs for their employees and is in partnership with Berkshire Hathaway and JPMorganChase.

“I think the most interesting thing they’re doing is following along the storyline of bringing down their own employee medical cost,” Becker said.

Jeff BeckerJeff Becker

Becker believes the company’s strategy is currently focused on cultivating the use of voice technology in healthcare and creating a “more shoppable healthcare experience” for patients and employers.

Some efforts are already proving fruitful. Others are more of a question mark. Becker pointed to Haven as one place that may not be making the kind of progress it set out to make.

The big picture

The Haven initiative is combining data, technology and resources from Amazon, Berkshire Hathaway and JPMorganChase to lower prescription drug costs and medical treatment for patients, according to the company’s vision statement.

Amazon announced the Boston-based joint venture in January 2018, but it didn’t get the name Haven until earlier this year. According to Haven’s vision statement, it’s not looking to make a profit as it seeks to find ways to lower healthcare costs. Haven plans to “reinvest any surplus” back into the initiative’s work to improve health outcomes and lower costs. While its current focus centers on employees of all three companies, the vision is to eventually share its innovations with others.

One of the first pilot healthcare services to grow out of the Haven initiative is Amazon Care, for Amazon employees in the Seattle area. The pilot service offers virtual and in-person care from Oasis Medical through a mobile app.

Becker called Amazon Care a “digital front door” for lowering employee healthcare costs by addressing an employee’s minor healthcare needs and potentially sidestepping costly urgent care visits.

“If they can reduce the overuse of the ER, the digital front door strategy will pay for itself,” he said.

Amazon Care also offers same-day prescription deliveries. The service utilizes Amazon’s $753 million acquisition of PillPack, a digital pharmacy that sorts medication by dose and delivers to a patient’s door. The PillPack acquisition has since been rebranded as PillPack by Amazon Pharmacy. This month, it started working with Blue Cross Blue Shield of Massachusetts by integrating pharmacy services into the health insurer’s “MyBlue” app.

Amazon also acquired a start-up called Health Navigator earlier this year, its first healthcare-related acquisition since PillPack. Health Navigator provides services such as online symptom checking and triage tools for digital health companies seeking to steer patients to the right location to seek care. The acquisition plays a role in the overall Amazon healthcare strategy as it will become part of the Amazon Care health service.

Kamaljit BeheraKamaljit Behera

“If you go by what Amazon’s spokesperson revealed, they want to eliminate costs associated with travel, as well as the inconvenience associated with waiting times for patients,” Kamaljit Behera, an analyst at Frost & Sullivan, said. “This is where we see Amazon coming strong into the telehealth space.”

The work Amazon is doing through the Haven initiative and pilots like Amazon Care points to what Becker thinks will be the wider Amazon healthcare strategy: a one-stop-shop for patients seeking healthcare options.

What if there was a marketplace for shoppable healthcare experiences?
Jeff BeckerAnalyst, Forrester

“What if there was a marketplace for shoppable healthcare experiences?” Becker said.

That idea is a long way off, but Becker believes Amazon is testing the idea now, starting with its Amazon Care pilot, to find ways to introduce technology and cut down on costs. Yet beyond Amazon Care, the Haven name hasn’t been associated with many projects, and Becker said there hasn’t been much in the way of updates about Haven and the work Haven CEO Atul Gawande, M.D., has been doing — something he will be looking for in 2020.

Behera echoed Becker, saying he believes the Amazon healthcare strategy going forward will be to extend health services with a more consumer-centric offering.

“Amazon will be looking to create a much more curated, personalized space,” Behera said.

Amazon will continue focus on voice

Amazon’s main goal appears to be lowering healthcare costs through its efforts with the Haven initiative, but one area Amazon will continue to develop is voice technology in healthcare, Becker said.

Early partnerships with health systems like Boston Children’s Hospital to build Alexa skills, or voice capabilities, served as indicators of the company’s interest in healthcare. In 2016, AWS partnered with Boston Children’s to start building Alexa skills for parents, Becker said. Recently, Amazon announced the creation of a skill that enables Alexa to refill prescriptions by voice, as well as remind patients to take their medication.

Amazon has continued to build out Alexa skills for the healthcare industry, and Becker speculates that Alexa will be the first virtual assistant to be HIPAA-compliant. Indeed, Amazon is creating healthcare skills that are etching closer to being HIPAA-compliant, such as Express Scripts and Cigna Health Today, which give eligible customers the ability to use voice to manage prescriptions and engage in health improvement programs.

Becker said Amazon has six ongoing protected health information-processing pilot programs. He described the company as the first to “cross the finish line” for voice-only two-factor authentication, which first authenticates a voice profile and then asks for a unique verbal pin to access protected health information (PHI).

“We’ve been waiting for some kind of way they are going to overcome the authentication requirements for starting to process PHI,” he said.

As Amazon builds healthcare skills for Alexa, Becker said AWS will eventually play a major role as a data processing platform for the Alexa voice skills. At the recent AWS re:Invent 2019 conference, Amazon introduced Transcribe Medical, which records patient-doctor interactions and turns voice into text. The service is helping clinicians with medical notes, but Becker believes it points to a longer-term use case as a data processing tool.

Transcribe Medical can be made more robust by combining it with services like Amazon Comprehend Medical, which uses natural language processing and machine learning to extract pertinent pieces of medical information from unstructured text, according to Becker.  

“If you have a HIPAA-compliant Alexa service, Transcribe Medical will convert those conversations to text, and then Comprehend Medical will identify clinical facts within that text,” Becker said. “You’re starting to see a more compelling set of capabilities for having medical conversations with consumers over a voice channel. I think that’s part of what they’re building.”

Frost & Sullivan’s Behera said Alexa and voice technology is an integral part of the Amazon healthcare strategy. It’s looking to address a known healthcare pain point — physician burnout — with emerging tech.

Based on industry estimates, 40% of physician burnout is related to the EHR, Behera said. While interacting with a patient, physicians enter information into a patient’s electronic health record, a process that can be burdensome and negatively impact the patient-physician relationship. Transcribe Medical, which is HIPAA eligible, could reduce the data entry burden. EHR vendor Cerner is partnering with Amazon to introduce the service as a digital assistant for providers.

“AI-driven interactive, virtual assistants are becoming a common background technology for medical transcription, documentation … and even customer relationship management,” Behera said.

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