Navigating Healthcare – Patient Safety and Personal Healthcare Management

Interviews Live From HIMSS 2019

This week I am talking to several guests live at HIMSS 2019

The Incrementalist Graphic HIMSS19 Part1

Rasu Shrestha, MD EVP & Chief Strategy Officer Atrium Health (@RasuShrestha), R. Hal Baker, MD SVP, CIO Wellspan, and Aneesh Chopra, President, CareJourney (@aneeshchopra)

Listen in to hear their thoughts on the latest innovations at HIMSS, what’s coming, the importance of shared values, bringing the humanity back to healthcare and the importance of bipartisan consensus on interoperability.


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


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Listen along on HealthcareNowRadio or on SoundCloud

Interviews Live From HIMSS 2019 was originally published on Dr Nick – The Incrementalist

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Summit

Keys to Successful Conferences

How do you describe the CNS Summit and what it offers – the word impossible springs to mind. Even the name can be a little misleading especially for medical folks who might look at that and think “Central Nervous System” but actually its stands for Collaborating for Novel Solutions

Innovation
CNS Summit Collaborating for Novel Solutions

This coming year will be the 10th year of the event and it continues to get better – testing new ideas and concepts for conferences to make the event valuable on multiple levels. The history and experience reminds me a lot of friendships and how they develop – the first interaction can be awkward and uncertain but intuitively you get a sense that the person you are talking to is someone who will be a friend pretty quickly (science suggests it is not minutes or seconds but a 1/10th of a second). Over time the relationship deepens and you learn more, and understand more, and how much you enjoy working with, learning from, sharing and sometimes just hanging out. So it is with the CNS Summit or more frequently know as “Summit”.

Photography
Photography Techniques from Experts

Where else can you come to a conference and get clever new ideas and techniques on how to use your mobile phone camera in interesting and creative ways from the incredibly talented and inspiration photographer Asa Mathat (recommend instagram @AsaMathat to get a sense of his incredible lens on the world and people). He is a renowned Photographer to the stars, creator of the big pink ribbon and at Summit – photographer for attendees as well!).

(Hint – Don’t think in traditional planes of movement and use your volume buttons as triggers and when you reach the end of your panorama, just reverse direction to switch it off).

CNSSummit Asa Mathat Photo Booth
Asa Mathat Photo Booth at Summit

Areas Covered

It hard to categorize the conference into a bucket – it benefits from being not too big so as not to overwhelm but large enough to attract an impressive diversity of participants and speakers. The mix includes leaders from the Pharmaceutical Industry, digital health, medical and device companies and technology companies.

Insights continued from cancer survivors who parlayed their personal experiences to focus on taming the data mountain in healthcare and science, the pharmaceutical executive who nearly died from a side effect of a drug that had a life changing effect on the personal trajectory that allowed for a rethinking the model of industrial production of pharmaceuticals.

CNSSummit WoodyWhisky
Woody’s Whisky Tasting Selection

Of course for this Whisky Librarian, there is even a special highlight put on by Woody Woodaman – the whisky tasting that raises money for a fund set up in his wife’s name Betty Jean Memorial Scholarship Fund to support nurse training. The conference floor is always offers new concepts and technologies – everything from taste experiences to the highly popular hugging booth set up by friend and colleague Andrew Chacko.

Each year is an eye opening experience full of surprises that Amir Kalali the conference Chief Curator keeps close to his chest like a proud parent who know’s he’s picked the best birthday gift for their child and can’t wait to reveal it.

This year there were many mind blowing presentations – for me “Breaking the Logjam in Medical Imaging” by Mary Lou Jepsen from Openwater that pushed the boundaries of wearables by offering a path to an MRI wearable. Sounds far fetched – not if you approach the problem with a different lens and understand that our photo sensor chips have reached a sensitivity of a micron – the wavelength of infrared. Combine this with the fact that our bodies are translucent to red and near infrared light – but red light scatters but this is not random, it is deterministic and reversible if you can record a hologram of it. So with some clever use of relatively old technology that allowed us to move from overhead foils

CNSSummit OverheadFoils
Remember these Devices?

to LCD projectors we are all accustomed to. This now allows the generation of ultrasound waves from small devices and using the change in phase of the light as it passes through the red light (you all know the doppler shift experiment you learnt in physics at school) they are now able to find vasculature at higher resolution than MRI and fMRI and even have additional capabilities to differentiate between oxygenated and non-oxygenated blood as achieved with the fMRI

Absorption of Hemoglobin for fMRI
Mapping Oxygenation of Blood in Real-time

But the resolution is now down to a few microns which is at the size of neurons, meaning they have the ability to see into our bodies at the detail of our nervous system… real time!

Image Resolution of Neurons
Neuron level granularity of Imaging

Combined with the early science that shows we can reconstruct what we are thinking and seeing based on analysis of our brain activity (Reconstructing visual experiences from brain activity evoked by natural movies, Nature – pdf). Most exciting the project is driven by a challenge to deliver a low cost, better imaging solution, to everyone, given that 2/3 of humanity lacks access to imaging.

Final Conference Day

 

The highlight for me was the last day – which according to my research and discussions with others, is just like every other conference poorly attended with many people missing the best elements.

It included two amazing presentations by the compassionate and gentle Daniel Friedland (Leading Well from Within), the wonderful, funny and insightful Chris Hadnagy (Social Hacker and previous guest on my radio show) and Stephanie Paul’s fun and eye opening Improv experience and included Asa Mathat participating and recording the activities with his unique eye. This picture captures the fun and learning we had as we learnt and connected

CNSSummit LastDayFun

So my Incremental step for you is set aside Oct 31 – Nov 3, 2019 for Summit 2109 (It is the 10th anniversary so I’m imagining Amir and the guiding council is thinking hard about making this event super special) and you to will have the learning opportunity and fun as you find a new friend in CNS Summit

CNSSummit AsaMathatandNick

And one more Incremental step – if you are taking the time to go to a conference, don’t head out before it finishes but rather plan to enjoy the last sessions where organizers often try to save the best till last.

Summit was originally published on Dr Nick – The Incrementalist

Consumer Rights Driven Data Access

The Bluebutton Innovator

 

The Incrementalist - Mark Scrimshire

This week I am talking to Mark Scrimshire (@eKiveMark) a fellow Walking Gallery member and Entrepreneur in Residence at NewWave and on assignment as Medicare Blue Button 2.0 Innovator at CMS where he is designing and implementing the new API to enable 53 million Medicare Beneficiaries to share their claims information with the applications, services and research programs they choose to trust.

His work extends back to 2010 when the initial concept of the Blue Button was conceptualized but it took several years before this started to really take off with the concept of View, Download and Transmit. One of the key Incremental Steps to get this interoperability rolled out centered on changing the positioning of HIPAA from a barrier to sharing and portability to an enabler. Ironic when you consider that it stands for “Health Insurance Portability and Accountability Act”! Listen in to find out the details behind the change and a key incremental step to progress – changing the messaging

Part of this changed messaging centers on the Office of Civil Rights (OCR) and the clear guidance to direct consumers to have the right to access their data in electronic format. As promised in the broadcast here is the Rights to Access Memo they issued in September 2015 and something I carry with me to all my medical appointments.

He shares his view on how to move toward interoperability and his incremental step connected with the Fast Healthcare Interoperability Resources (FHIR, pronounced “Fire”) set of Resources and removing complexity and simplifying the approach the is a recurring theme for Incremental Improvements.

Don’t let perfection stand in the way of progress

You can read more about the project in the FHIR Wiki he mentioned here. Listen in to hear Mark talk about the new project and how he is turning the oxymoron of Explanation of Benefits (EOB) which fails to provide insights to the people it is directed at and how the DaVinci project. The move from the old model of Fee for Service (FFS) to paying for outcomes is also driving a whole shift in data accessibility and utility and willingness to share which is exciting for our the consumer rights driven access movement.

Their Incremental steps to improvement include the huddle but listen in to hear what other incremental steps you may be missing that has added significantly to their team-based approach, coordination and success


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Consumer Rights Driven Data Access was originally published on Dr Nick – The Incrementalist

Interoperability in Healthcare

Getting to Nationwide Interoperability

Data
Free Flow Data Sharing

Unfortunately, the existing healthcare system incentives behavior that is in opposition to the goal of scalable, nationwide, vendor-neutral interoperability. Our model has multiple groups who have a vested interest in the control and ownership of data (for example Payors, Providers, Patients). Each has their own economic and commercial drivers and in many instances, these do not coincide with the open sharing of data. In a system that is driven by activity and delivering care (Fee for Service) sharing data could mean a reduction in work and income. Until our reimbursement system moves to a more holistic care model that focuses on wellness and outcomes and incentivizes behavior that delivers better health and outcomes for patients through cooperative and coordinated care and ultimately equitably rewards all the contributors to these outcomes we will remain stuck in the quagmire of limited interoperability.

The Patient at the Center of Data Exchange

I believe as do many others that the patient is at the center of everything we do and deliver in healthcare. By placing the patient and their information at the center of care we empower them and enable a model that moves away from the historical paternalistic delivery of healthcare to patient-centered and enabled care. It does come with challenges since many people contribute to that care and the current administrative and financial configuration focus the management and ownership of data with providers, healthcare systems and payors. While many patients want access to their data and some even want to own and manage it, many do not and are ill-equipped to be responsible for this data. What may emerge are independent services and providers who aggregate, manage, secure and service patient data on behalf of patients – much as banks do with our money. There are many technologies on the horizon that offer a potential path to achieve this and blockchain represents an interesting innovation of decentralized secured data that offers individualized control and dynamic revocation options for access.

Frictionless Data Flow

The key to an interconnected care model is the free flow of data between all the various areas that are responsible for delivering care. We moved away from the single index card medical record held by your personal physician who was the focal point of your care and care coordination to a distributed team-based model of care that encompasses multiple areas and people. The only way this team can deliver excellent care is through the frictionless flow of enhanced data and knowledge. This information flow must include the patient and all their family members that are authorized, interested and engaged in their care. Data should be shared with the patient’s consent with everyone concerned and available for as long as it is needed to deliver care but this access should be flexible enough to allow it to be revoked or removed when it is no longer needed or necessary

 

Interoperability in Healthcare was originally published on Dr Nick – The Incrementalist

The NHS at 70

Healthcare, NHS

The crown jewels of British society

The NHS was the crown jewels of British society providing healthcare to every member of society no matter who they were, where they came from and what personal resources they had. It was the great leveler of society creating a single standard of care and service that was accessible to rich, poor and disenfranchised and it was well loved.
To me personally, it was my guide and educator – I was lucky to attend one of the great London medical schools – The Royal Free Hospital School of Medicine. The “Free” hospital created to treat all comers and the original medical school (The London School of Medicine for Women) for women created in an era when women were not admitted to British Medical schools

That hospital and the NHS provided me with a first-class medical school education, access to groundbreaking research that included the early work and discoveries around HIV/AIDS, Hemophilia, Liver disorders and beyond.
The staff in every department were friends, colleagues and members of a community that were family and all pulled in the same direction – that of the patient. I spent time working in different areas during my time, staffing the manual telephone switchboard, helping the porters and security staff, nurses, technologists, and maintenance and quickly realized the well-oiled NHS machine demanded a family of committed people to make it work and deliver outstanding care each and every day.

What Could We Do Better

As we know today, and probably knew 70 years ago and before, healthcare is as much about our environment and resources as it is about medical treatments, technology, and innovation. We know that 60-80% of health is attributable to lifestyle but fail to take account of this in the NHS and in the majority of health systems from around the world.

 

We need a WellCare system not Healthcare

 

The system spends large sums of money providing medications to the population but fails to take account of the most basic needs of the population and acknowledge that food is also a drug. What we put into our bodies contributes to our health and well-being. Failing to acknowledge and manage these elements of health with sleep as the foundation and exercise and nutrition built on top has created a system that treats the failing of these issues at great financial and personal patient cost. Investing in the prevention would create a WellCare system and not the Healthcare System that the NHS is.

Manage and Allocate the Limited Resources with Transparency

It’s an unpleasant fact that few want to address or even acknowledge but the reality of treating people is that in this day and age of innovation, scientific progress and developments we could spend every last penny on treating patients. There is an unlimited supply of possible treatments and a never-ending procession of people needing those treatments. But not all treatments are created equally – some don’t work, some are harmful and in the cases of those that do work there is the wide disparity in the effectiveness and cost. Any healthcare system needs a means of assessing the effectiveness of treatments that includes the financial and resource cost linked to the improvements. The problem with a “free” (the NHS is not free – it is simply free at the point of care, paid for through taxation of the individuals) is the inducement of un-economic behavior by individuals looking for every last treatment option no matter the cost or effectiveness. That path is unsustainable and breaks the system and ultimately harms patients.

Enable Informed Decision Making for Everyone

Doctors Die Differently and do so because they understand the economic and personal tradeoffs between treatments and quality of life. In the data presented by the Johns Hopkins Study of a Lifetime we see a big discrepancy in treatment choices between doctors and everyone else. We make our choices in the context of the knowledge of effectiveness weighed against the personal cost of treatments and quality of life impact. An open an honest assessment of treatment that is clinically effective would level the disparity in treatment choices selected by patients. As a society, we struggle to discuss end of life but it is a reality that everyone faces and we must find ways to educate and support people through all aspects of life and death.

Technology and innovation is essential to the future of the NHS

The future of a scalable meritocratic system accessible to all that does not bankrupt society will be dependent on technology and innovation. Humans remain the core constituents of any compassionate caring system and technology is a supporting player. But as Michael Dell put it:

Technology has always been about enabling human potential

Michael Dell, Dell
Technology has always been about Enabling Human Potential

Technology does not replace the human beings or interaction but rather augments it in ways that extend our capabilities and improves the accessibility and economics.

It is an impossible task for humans to process the amount of data currently being generated about our patients, the knowledge derived from research and advances in science and put it into the context of treatments at the point of care when it is needed most.

We have expanded beyond the human brains capacity to absorb, process and apply the knowledge and must rely on technology to augment the brains abilities and place information into the context of the individual patient and the care choices available.

Selecting the innovations that deliver the most value

Innovation impacts each and every area of the NHS and will continue to do so but the challenge will be to select the innovations that deliver the most value to the largest number of people based on scientific peer reviews.

Innovation is not confined to the clinical treatment but extends to every element of the NHS system and the delivery of wellness care. It is changing the design of facilities to include features that improve care and outcomes – for example by adding natural light and open spaces.

Innovation is allowing patients the option to access their care team at any time and from any location – for example bringing the care team to the patient as we used to do with home visits but now using technology to extend the reach and scalability.

Innovation is building rooms and beds that can be efficiently and effectively cleaned between visits while maintaining comfort and welcoming surroundings. It is using available data to predict potential health issues before they occur and reaching out to patients helping to guide them to better healthier choices and wellness. Innovation is allowing parents to stay with their child in the hospital when they are sick and in need of care in comfortable and caring surroundings.

Innovation is offering dignity and compassion to those facing death and offering realistic options for no treatment and hospice care.

What can Britain and the NHS learn from the rest of the world?

Over 700 years ago, China had village doctors who were paid by the villagers when they were well but received no money when the patients were sick. This is the principle of wellness over sickness care. In Norway, they have a wide and uniform implementation of a digital health record that is accessible to everyone that needs it including the patient – tied together with a unique patient identifier designed for that purpose. One Citizen, one record.

The European Union allows citizens to cross borders and different health systems but to receive urgent care while traveling and administers the cross-country charges, managing fees and removing the patient from worrying about payments while they are sick and abroad.

Look also to Africa and the innovation that takes place on a continent with access to far fewer resources and technology to see what’s possible with the existing technology. Small incremental steps in using technology to boost healthcare services such as text messaging have been wildly successful and yet remain simple, easy to implement and understand and accessible through all social groups in society.

In Rwanda, they have integrated drone delivery for hard-to-reach locations, offering lifesaving support that was previously almost impossible. Expect to see more of this and bi-directional capabilities for resources, tests, and samples as well as lifesaving treatments.

Finally, in Korea, they have a culture of celebrating aging and the elderly that includes dignity in end of life and the inclusion of everyone in the family and their health. Korean culture sees the 60th and 70th birthday as a big family affair and the inclusion and the universal expectation that roles reverse once parents age, and that it is an adult child’s honorable duty to care for his or her parents’ health.”

A version of this appeared previously here

The NHS at 70 was originally published on Dr Nick – The Incrementalist

Should You be Taking a Statin

Statin, Cholesterol, Heart
Are statins the wonder drug for your Heart Health

 

The answer to that question is complex and individual and before thinking about that you should have a basic understanding of cholesterol in your body. You can learn about this from my video and blog post

Statins

In the previous episode, I talked about Cholesterol in your body. This week as a follow up I’m talking about Statins, a group of drugs that lower the level of cholesterol in the body. They work by acting on the liver’s mechanism for producing cholesterol inhibiting the enzyme Hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase).

Anatomy
The Human Circulatory System

We know that cholesterol is closely linked to atherosclerosis – the formation of plaques that build up on the walls of our arteries and contain cholesterol and that these plaques can rupture or break off and cause blockages that cause cardiovascular disease that ranges from the mild decrease in blood flow to our limbs to the severe effects that throw blood clots into our brains and heart causing strokes or heart attacks. But as we learned last time – cholesterol is not all bad – it is an essential part of our body systems making up parts of cell membranes and integral to several signaling molecules.

Statins are also known to have additional effects beyond the simple reduction in cholesterol levels and production in our body and several studies have shown that these drugs also reduce inflammation in the cell walls which is not connected to the cholesterol-lowing effect. In fact, this effect occurs rapidly and is seen as soon as 2 weeks after starting statin therapy

Statins Drugs

Drugs
Medication choices

There are multiple Statins around the oldest and best known is Atorvastatin (widely known by its brand name Lipitor) with its breakout general usage in 1996. The good news is this drug is off patent and there are plenty of low-cost generic options available and there is lots of safety data gathered given it has been in widespread use for over 20 years.

But Statins are not side-effect free and some find themselves suffering from constipation, diarrhea, and fatigue and in some 5-10% of people muscle cramps that can make the drug intolerable. This can be mitigated with some of the newer variant drugs that can help mitigate or even completely reduce the muscle cramps and other side effects. There is a rare and significant effect of causing diabetes in a small percentage of patient’s which is an important factor to consider when considering if Statins are right for you.

New Research on Statin Therapy

There has been lots of research and trials and the most recent I mentioned in the video the HOPE-3 trial which had a multifactorial design – meaning multiple variations on treatment therapies were tested in different populations.

They had a diverse group of patients divided up into multiple groups in a 2×2 factorial design that had groups being treated with a statin, an Angiotensin-converting enzyme (ACE) inhibitor for blood pressure and a diuretic hydrochlorothiazide also for blood pressure (BP). They had 12,000 people with a follow up to 5 years and they maintained good adherence for drugs of around 75%.
Overall, the anti-hypertensives did not reduce the risk of cardiovascular events at all – but there were differences depending on whether or not you had hypertension when you entered the trial. Interestingly the combined statin with an antihypertensive treatment was no better than a statin alone. And the data offered a clear benefit for Statins for those at intermediate risk of cardiovascular disease.

The details of this are nicely summarized here and the article includes links to the 3 published studies that were published from the data. One of the specific questions answered by this study is on that one cardiologist friend of mine and I have discussed before – should Statins be placed in the drinking water like fluoride. Given the cost and the side effects associated with statins, the answer is no for economic reasons as well as increased risk of side effects.

In the intervening time since I recorded this video another paper was published:
Finding the Balance Between Benefits and Harms When Using Statins for Primary Prevention of Cardiovascular Disease: A Modeling Study, and a new set of guidelines from the American College of Cardiology (ACA)/American Heart Association (AHA) on the management of cholesterol in the blood: 2018 ACC/AHA Multi society Guideline on the Management of Blood Cholesterol

Which emphasizes a heart-healthy lifestyle but then details some very specific “high-intensity” statins to focus on specific cholesterol levels in people who are at high risk or with proven clinical cardiovascular disease (they reference ASCVD or atherosclerotic cardiovascular disease) alongside detailed clinical guidelines for stating therapy based on specific risk and disease assessments in individuals. There are too many variations to make any generalization beyond what I stated in the video – start with the incremental step of knowing your numbers and the details of your family history and medical history as contributing factors to your risk assessment to take with you and discuss with your doctor to decide what’s right for you

Once you have your numbers you should calculate your 10-year risk of heart disease or stroke using the Atherosclerotic Cardiovascular Disease (ASCVD) algorithm published in 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. This is available from several sources including this from MDCalc or this one which includes a spreadsheet you can download to plug in your values as well.
To include the new updated guidelines from 2017 and the ASCVD Risk Estimator Plus tool (background available here) you can download the app with updated guidelines from 2017 for Apple iOS but Android is a little more challenging with a generalized cardiology app which does not get as good reviews.

Ultimately the decision is a very personal one and is driven by data and supported by clinical evidence. There are no quick global answers, but it is an important decision for everyone to consider, especially if you have any contributing factors in your family history, past medical history or are suffering from any aspects of cardiovascular disease.

Listen in to hear the details Statin Therapy and if its right for you

Incremental steps – Deciding on a Statin

  • Measure your Blood Cholesterol
    Gather the details of your medical history
    Use the ASCVD calculator to give you a guide based on the clinical research
    Bring everything to your doctor and discuss the evidence data and make a personalized decision together

 

The evidence is clear for those in the groups that have treatment with a statin recommended that the benefits outweigh the risks and side effects.

Should You be Taking a Statin was originally published on Dr Nick – The Incrementalist

Using Advanced Trauma Life Support Methodology in Population Health

 Preventative Health for Everyone

 

NewImage

This week I am talking Joshua Scalar, MD, MPH, Chief Medical Officer for BioIQ where they are working to seamlessly connect people to preventative health testing by removing the friction from the system and allowing as many people as possible to access essential, cost-effective life saving preventative testing services.

Josh had an interesting path to his current role – find out how a Saxophone playing band member became a passionate advocate for patient engagement and widespread and easy access to preventative services

Hear how Advanced Trauma Life Support (ATLS) insights offer a model and guide for the triage and delivery of preventative care that should address a problem that by some estimates has only 8% of people accessing fully validated life-saving preventative care opportunities in the United States

Like many of my other guests, Josh made the point that one of the clear incremental steps to getting patients and consumers to access preventative services is

Making the right choice the easiest choice

Hear how he and his team have addressed a basic problem of colonoscopy screening that is an effective and well-tested method of picking up and preventing untimely death from colon cancer but is still poorly adopted. As he points out – colon cancer killed 50,000 people in 2017 – that’s more than the opioid epidemic did but it continues to lack the focus and attention warranted.

Listen in below to find out how this can be applied to Diabetic Retinopathy – preventing blindness that is a high risk for Diabetic patients


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


 

Listen along on HealthcareNowRadio or on SoundCloud

Using Advanced Trauma Life Support Methodology in Population Health was originally published on Dr Nick – The Incrementalist

Making it Easier to do the Right Thing

Behavioral Health for Positive Impact

Behavior

This week I am talking to Matt Wallaert (@mattwallaert), Chief Behavioral Officer at Clover Health. I have listened to Matt on a few occasions, most recently at the FitBit Captivate event in Chicago so I was excited to get to talk to him one on one.

Matt plays an unusual and atypical role in Clover Health – he is their Chief Behavioral Officer, a title and role that is not commonly found. He is a Social Psychologist who focuses on Judgement and Decision Making and is most well known for applying behavioral science to practical problems.

We explore behavioral health influences and how we can create interventions that will have a positive impact. How do we create incremental steps and test these and then roll out of programs to have a positive impact on health? He wanted to have an impact and wanted to make things better for people and over the course of his career has managed to do so in many places but is now focused on healthcare and specifically personal health. There’s a recurring theme in many of my INcremental interviews and I heard it again from Matt:

Assume you are going to fail

As Matt puts it – “don’t set up a durable process – for example, if you are doing a mailing do that yourself vs getting your marketing department to create the mailing”. Then head out to the next step – a Test. It is not hard to find behavioral changes that work – but that’s not the only requirement as the change has to work well enough and are scalable enough that you really want to roll them out widely.

Incremental Step to Behavioral Health

It’s not just finding good behavioral changes but rather things that are worthwhile and scalable

“If behavior is your outcome and science is your method – then you are a behavioral scientist”

As Matt says we have to make it easier to do the right thing and not blame individual choices and health behaviors when we make poor health, decisions. Listen in to find out why there are significant cultural differences in flu vaccination take up rates and what incremental steps can be taken to improve on that and hear why it is important not to blame people for poor health behaviors. Learn how they are behaving like Netflix or Pandora that can can match you to the right videos or music we should be able to match you to the right doctor

 


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Making it Easier to do the Right Thing was originally published on Dr Nick – The Incrementalist

Improving Healthcare’s Security Posture

Blackhat

Healthcare’s Security Posture

As part of my interview series from BlackHat I spoke with Mike Weber VP Coalfire Labs – they are a large Cybersecurity Systems provider focused on securing transactions in the cloud working with all if not most of the cloud providers. Coalfire just released their Penetration Risk Report that included a special section on Healthcare. Not surprisingly the news wasn’t good showing that healthcare had the worst “External Posture” with the least security for anything that can be seen by an attacker – external facing systems such as routers, firewalls etc.

Healthcare

The biggest issue was with legacy systems and many instances upgrades installed but the legacy and unsecured systems remain in use.

Healthcare

Listen in to the interview and hear Mike’s thoughts on Incremental Steps to combat the Security challenges faced in healthcare. As he and others have pointed out Medical records are high risk because they have such a long shelf life offering a rich vein to exploit for anyone able to steal these records.

 

Incremental Steps for Improving Healthcare’s Security Posture

 

  • Upgrade Old Systems and Importantly plan retirement for old systems as part of the upgrade
  • Consolidated Your audit program to Decrease Audit Fatigue
  • Prioritize Your “Crown Jewel’s” of the data and Systems you are protecting

Here’s the short list:

  1. Personal data is the top target (highest value) – medical identity information has a smaller market
  2. Platform Access – and the ability to install ransomware
  3. Encrypt everything

Encrypt

Improving Healthcare’s Security Posture was originally published on Dr Nick – The Incrementalist

Unbreakable Encryption

Encryption Algorithms Under Siege

NewImage

Over the course of history, the development and subsequent breaking of encryption standards have been a constant cycle. As new keys were developed so they were broken and the speed of with which new keys were broken has increased. Modern day encryption “Data Encryption Standard” or DES was launched int he 70’s with a 56-bit key (64 bits but with 8 parity bits). This encryption was cracked in 1999 and with the likelihood, looming NIST launched a new search for encryption standards giving rise to Advanced Encryption Standard (AES) (aka Rijndael) with 256-bit keys and is under attack both cryptographically and by brute force of faster computers including as and when they arrive. As a result, NIST is seeking new proposals for cryptographic standards to replace AES when it is broken – but with the advent of Quantum computing this will be broken too

Unbreakable Encryption

NewImage

I spoke with John Prisco, President & CEO for QuantumXchange who in his words are pioneering unbreakable encryption. I know what you’re thinking – the idea of something being unbreakable/unhackable seems impossible and I was dubious as well.

But here’s what’s interesting – the foundation of the technology is the Heisenberg (no not that Heisenberg) uncertainty principle

 

You have to go deep into theoretical quantum physics to understand the background to this and while no expert I’m fascinated by the quantum world. This explanation in the Encyclopedia Brittanica is helpful comparing the concept to measuring the pressure of air in your tires TL;dr you can’t because as soon as you attach the pressure gauge you change the pressure. Essentially you can never know with perfect accuracy both of the position and velocity of a particle. It is impossible to determine accurately both the position and the direction and speed of a particle at the same instant.  You could learn more from the always brilliant Richard Feynman video Lecture: Probability and Uncertainty in Quantum Mechanics

Cryptography

Single Photon Based Encryption Keys

That uncertainty is a physical property, not a mathematical derivation (the foundation of encryption). QuantumXchange uses the quantum properties of single photons (light) to exchange data between two locations, with keys derived from the exchanged quantum information. The keys are Tamper Evident: Any attempt to intercept (look at or break) the key will change the state thanks to Heisenberg Uncertainty Principle causing a change in quantum state thereby corrupting the key – in which case those keys are rejected and a new pair created.

All this takes place on “Dark Fiber” from Boston to Washington DC and offering this up to customers in the healthcare and financial services markets and have examples already in play of oil rigs using their Quantum Keys to secure the huge numbers of IoT devices that are used in critical infrastructure and control for oil drilling and production

This concept is especially important for Healthcare data which has the longest shelf life of any data in the industry so protecting it over extended periods of time is essential if we are to maintain patients privacy and confidentiality

Here’s the Interview:

 

Unbreakable Encryption was originally published on Dr Nick – The Incrementalist