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June 28, 2020 News 5 Comments

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Cybersecurity firm Expanse finds from monitoring the Internet traffic of six unnamed Fortune 500 healthcare companies that:

  • Half are getting traffic from exposed Remote Desktop Protocol servers, which allows brute force password guessing.
  • One-third are receiving Internet accesses from the deprecated Server Message Block v1 that is used for printer and port access, a popular way to spread major attacks such as Petya and Wannacry.
  • One-third showed regular traffic from servers and devices in Iran, opening them to the possibility of state-sponsored attacks in the absence of geographic traffic filtering.
  • Every company had outbound Tor traffic originating from its network, indicating that their security policies do not prohibit it.

Some of the RDP servers had brute-force password-guessing attacks underway and did not have Network Level Authentication enabled.

The SMB traffic indicates that those companies were already the victim of data exfiltration.


HIStalk Announcements and Requests

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Three-fourths of poll respondents who have had a recent telehealth encounter provided their pre-visit information via an electronic form or upon being asked by someone other than the provider. Some gave their information directly to the clinician, while 12% either weren’t asked about allergies, meds, history, etc. or had to volunteer it.

New poll to your right or here: When will healthcare conference attendance rise to 75% of pre-COVID levels? Your answer will need to incorporate your predictions of the underlying factors, such as availability of an effective COVID-19 vaccine, healthcare business conditions, attending conferences versus alternatives, etc.

I was thinking about the challenge of getting people to wear masks despite their indifference, ignorance, or pathetic choice of ways to protest whatever it is that they’re angry about. My idea – hire marketing people to mount multiple targeted campaigns like the successful “Don’t Mess with Texas” anti-littering one from years ago. We know now that the pandemic isn’t going away soon, so we have time to convene focus groups and think of creative ways to encourage people to put them on given that rational thought isn’t doing it. I suggest distributing free masks that bear the same kind of lowbrow messages that people are willing to deface their cars to display publicly — think stick figure families, cartoons of a Ford truck owner peeing on a Chevy, 13.1 and 26.2 ones (ironically placed on vehicles), or those oval ones with made-up airport codes touting town pride. We know that marketing and social media advertising change behavior in ways that science and empathy won’t.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

Microsoft will close all of its physical stores.


People

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Predictive EHR workflow vendor Wellsheet hires Frederik Lindberg, MD, PhD (Friend Health) as VP of product management.


Announcements and Implementations

Redox publishes a podcast that describes its recent layoff of 44 employees and how it made the decisions that were required, making the process transparent in hoping to help other companies that are navigating their recovery from the pandemic.


Government and Politics

The White House asks the Supreme Court to overturn the Affordable Care Act, which would eliminate health coverage for 23 million Americans.


COVID-19

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Case counts spiked in 36 states over the weekend, with Florida’s nearly 10,000 new cases on Saturday rivalling New York’s worst historic levels. More than 40,000 new cases were reported nationally on Friday as the CDC reports that actual numbers are likely six to 24 times higher. The US death count is at 127,000 as experts question whether the economic pain that was inflicted during the months-long but effective national shutdown was worth it now that complacence has raised the “flatten the curve” imperative once again.

Texas Medical Center stops publishing its base and surge ICU numbers, right after Houston area hospitals walked back their “our ICUs are about to be overwhelmed” message just 18 hours later in saying that they have plenty of capacity and their earlier dire warnings were overly alarming. This came days after the governor ordered hospitals in four Texas counties to stop performing profitable elective surgeries. Some Harris County hospitals are ignoring the governor’s order and the Texas Hospital Association says individual hospitals should be able to decide for themselves whether to perform elective procedures. The state has 5,500 patients hospitalized with COVID-19, extending its 16-day string of ever-increasing inpatient counts. TMC just announced that it will bring back the missing information in a form that better explains the capacity situation.

Texas reports hours-long lines for COVID-19 testing, along with limited capacity due to a shortage of supplies and crashing of websites for testing sign-up.

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In Australia, the government’s $2 million COVID-19 contact tracing app has been downloaded 6 million times, but has yet to identify any contacts that hadn’t already been found via manual tracing. The app seems to have problem when the IPhone of the user or their contact is locked. Problems have also been noted with IPhones and Android phones sharing information. Of 926 new cases, only 40 people had the app installed and allowed health officials to look at the contacts it had flagged.

Former FDA Commissioner Scott Gottlieb, MD predicts that schools won’t open in the South in the fall due to the overwhelming infection spread. He also notes that the US was doing a poor job of contact tracing even before the daily new infection count hit 40,000, where such activity becomes basically impossible anyway.

A New York Times report says that college towns will be hit hard economically from COVID-19 due to reduced on-campus living, cancelled sporting events, and closed bars, calling out specifically campuses in rural areas such as those of Cornell, Amherst, and Penn State.

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Arizona — which still hasn’t closed bars, mandated the wearing of masks, or prohibited large indoor political rallies without masks — publishes a point system to decide who gets ICU resources versus those who will be left to die without them. Arizona has 2,700 patients hospitalized with known or suspected COVID-19 (triple the number from a month ago) and nearly 500 are on ventilators (double the month-ago count). Nearly 90% of adult ICU beds are occupied. Imagine how bad it would be if the mostly elderly snowbirds in Arizona and Florida weren’t gone for cooler weather elsewhere.

New York State reported just five COVID-19 deaths on Saturday versus its previous peaks of around 800. The state mandates a 14-day quarantine for visitors from high-infection states.

Harvard’s Ashish Jha, MD, MPH raises the interesting point that while young patients have lower COVID-19 mortality rates than older ones, it is true of every disease that younger people have better survival odds. He looks at it differently: a 40-year-old patient who is admitted for COVID-19 has the same mortality rate as a 70-year-old who has a heart attack. Coronavirus still kills 5% of hospitalized patients aged 35-44 and Florida’s numbers are skewing much worse.

Members of the Congressional Hispanic Caucus demand that HHS explain its HHS Protect COVID-19 data project, for which it issued a $25 million contract with Palantir, whose data products are used by ICE to find and arrest immigrants. HHS says the HHS Protect information is de-identified. The CIA is an investor in the company.

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UCSF’s Bob Wachter, MD summarizes the present state nicely.


Sponsor Updates

  • PMD VP of Business Development Ted Ranney, MBA publishes a Medical Economics article titled “Telehealth best practices: Building a long-term workflow.”
  • Nuance announces that its AI Marketplace for Diagnostic Imaging is accelerating AI adoption for radiologists at leading healthcare systems.
  • OmniSys and RedSail Technology announce a strategic partnership to bring innovative clinical and revenue cycle solutions to independent and long-term care pharmacy markets.
  • IDC recognizes Pure Storage as a top five vendor in the OEM storage space.
  • Redox releases a new podcast, “Layoffs.”
  • Saykara launches a YouTube channel.
  • Summit Healthcare publishes a new case study, “Surgery Partners: Improving Processes with RPA Across all Meditech Platforms; Magic, 5.x, 6.x, and Expanse.”
  • Researchers publish “Factors Associated with Prescribing Oral Disease Modifying Agents in Multiple Sclerosis: A Real-World Analysis of Electronic Medical Records” based on data from TriNetX’s network.

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Currently there are "5 comments" on this Article:

  1. Can anyone validate the “new” case numbers and how they are calculated currently? Do they include net new positive cases + repeat positive cases (those that are inpatient and tested multiple times, etc.) + antibody positive cases + anything else?? It is difficult to ascertain.

    Thank you.

    • Great question. I fear that whatever results we see have been politically optimized at local and state levels in the absence of federal oversight. I also wish we could see the outcomes of admitted patients who tested positive and who concurrently had first diagnoses of lung, heart, brain, and blood problems since the general public sees COVID outcomes as flu-like binary, where you either die or are cured without sequelae and with immunity, and it appears that the unpleasant health journey only begins at discharge. The EHR should be able to easily answer those questions, although how to react to the findings in the absence of any effective treatment options is the real challenge.

      • I am afraid you are too correct in your assessment of the veracity of some state data. We can look at the assertions and testimony of Rebekah Jones, the Florida state Chief Data Scientist who describes the manipulation of data as an example. There are other states that appear to be in similar states of data invalidity for political purposes. This is on top of the problems with data quality that are just inherent to EHR information.

        I am not sure how to see these trends and infection byproducts in a single EHR, unless that is a combinatorial EHR (acute, ambulatory, ED, etc) or through a data aggregator. If our testing was both active and historical (covid markers) then we could tag patients then watch their subsequent treatments, Dx, and Rx — maybe through case reporting? But again, if you take that route then you have to trust the health departments to not be influenced by politics.

        New CQMs around CV-19 might be nice, especially if they were hooked to a FHIR based Clinical Decision Support system.

        I hope that in the end we look at the topography of our health systems and craft a plan for the next epi/pan-demic: zika, ebola, measles, mumps, vaping, opioid, or coronavirus next. The problem space won’t change but if we look back at our last 20 years of history we can see that it will only be a year or two before we are in a similar place.

    • According to The COVID Tracking Project (which is probably the most reliable source of US data) FAQs:

      ~~
      Are you reporting antibody (serology) tests or PCR (viral) tests?

      We are currently capturing both data about antibody tests and data about PCR tests, but to our best knowledge we are only publishing data about PCR tests. Some states do not clarify what kind of tests they are reporting. If states are silently including antibody test data in their overall test data, our dataset will also include it. Once we are sure that a majority of states are reliably reporting antibody test data, we will publish national- and state-level data about antibody testing.
      ~~

      Your other question regarding whether same individual can appear multiple times – I believe the answer to that is yes because the data that is being reported is test level data and is not rolled up to an individual person level (which will be hard to do anyways since the US unlike many countries doesn’t have a national master patient index program). At one point in time, some states like CA were trying to roll up to individual level but they gave up within a few weeks.







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