This Is The Fax Machine Story Of The Year I Reckon. Surely The USA In 2020 Can Do Better?

This appeared in the New Your Times last week:

Bottleneck for U.S. Coronavirus Response: The Fax Machine

Before public health officials can manage the pandemic, they must deal with a broken data system that sends incomplete results in formats they can’t easily use.

By Sarah Kliff and Margot Sanger-Katz

·         July 13, 2020

Public health officials in Houston are struggling to keep up with one of the nation’s largest coronavirus outbreaks. They are desperate to trace cases and quarantine patients before they spread the virus to others. But first, they must negotiate with the office fax machine.

The machine at the Harris County Public Health department in Houston recently became overwhelmed when one laboratory sent a large batch of test results, spraying hundreds of pages all over the floor.

“Picture the image of hundreds of faxes coming through, and the machine just shooting out paper,” said Dr. Umair Shah, executive director of the department. The county has so far recorded more than 40,000 coronavirus cases.

Some doctors fax coronavirus tests to Dr. Shah’s personal number, too. Those papers are put in an envelope marked “confidential” and walked to the epidemiology department.

As hard as the United States works to control coronavirus, it keeps running into problems caused by its fragmented health system, a jumble of old and new technology, and data standards that don’t meet epidemiologists’ needs. Public health officials and private laboratories have managed to expand testing to more than half a million performed daily, but they do not have a system that can smoothly handle that avalanche of results.

Health departments track the virus’s spread with a distinctly American patchwork: a reporting system in which some test results arrive via smooth data feeds but others come by phone, email, physical mail or fax, a technology retained because it complies with digital privacy standards for health information. These reports often come in duplicate, go to the wrong health department, or are missing crucial information such as a patient’s phone number or address.

More here:

https://www.nytimes.com/2020/07/13/upshot/coronavirus-response-fax-machines.html

Another reason it seems to move to some secure electronic messaging technology, I guess. Even e-Fax would save a lot of trees!

With the cases (and reports) now numbering in the millions there have been more than a few trees felled to allow this steam communication to happen – very slowly!

Interestingly, later in the article, a Digital Health expert points out that all sorts of issues also arise because of the USA’s refusal to implement a unique patient identifier – despite recognising the need decades ago!

The USA really does need a major investment in basic Digital Health infrastructure for just this sort of situation as well as the routine operations of the health sector!

David.

Yet Another Over Hyped ADHA Press Release That Warrants Close Reading To Sort Fact From Spin!

This appeared a few days ago.

https://www.digitalhealth.gov.au/news-and-events/news/media-release-medical-profession-and-the-community-embracing-technology-and-digital-health

Media release - Medical profession and the community embracing technology and digital health

13 July, 2020: New research commissioned by the Australian Digital Health Agency confirms anecdotal evidence that Australians are now more open to using digital technology in healthcare and can see the importance of technology to improve health outcomes.

The Agency focus over 2019 was connecting primary healthcare providers such as GPs and pharmacists to the My Health Record system and to date over 90% of both professions are now registered to upload and view documents.

A new survey of healthcare practitioners conducted in late April shows that in particular, 90% of specialists are now open to using more technology when caring for their patients, including using apps and online self-service.

In another survey which evaluates consumer engagement with digital health services there has been a marked increase in awareness of telehealth and remote healthcare since the end of March, with the majority of people surveyed saying that they can get access to healthcare services when they need them. This survey also shows that there are still some gaps in people’s knowledge about the availability of personal health information digitally, and some concerns that their healthcare providers may not use technology in the best possible way.

Agency CEO Bettina McMahon said the research provides insight on attitudinal change towards the value of technology in healthcare in the face of COVID-19 as providers and consumers had embraced digital health tools and telehealth services.

“We’ve seen a significant increase in digital health over the past three months as the health system has fast tracked its adoption of technology to deliver health services in a COVID world. This new research shows that we can expect digital health to remain a feature of healthcare into the future, now that consumers and healthcare professionals have experienced the convenience and benefits technology can bring.”

“Our research also reaffirms that the technology available may not be ideal for everyone and that not all healthcare providers want to use it. The Agency will continue to work with the health tech sector to improve the experience for healthcare professionals using IT in busy healthcare settings and the connection of their systems across the health sector.”

“Healthcare practitioners across the board are keen to do training in digital health services,” Ms McMahon said. “That is why we are working with peak associations to develop professional development programs such as the one for nurses and midwives which will be launched later this year. We have also turned our attention to improving specialists’ adoption of technology – including the My Health Record – by working with the software companies in this market and developing education and training materials.”

The Agency’s initial activities to increase use of national digital services including the My Health Record was focussed on GPs, community pharmacists, public and private hospitals, and pathology and diagnostic imaging laboratories. It made sense to firstly work with healthcare providers who consumers deal with most and where levels of computerisation were already high. “We are working with the tech industry to integrate standard medical terminology, national patient and provider identifiers, standardised secure messaging and the My Health Record into the systems specialists and other providers are already using – enabling them to access the most up to date patient health information in a safe, secure, and simple way,” Ms McMahon said.

“The importance of using technology to support our health workers to improve patient outcomes cannot be underestimated. We are working hard to improve their experience with technology so that Australians can benefit from digital health in the ‘new normal’ of health service delivery.”

Key My Health Record statistics – May 2020

• 22.77 million total My Health Records
• More than 19.2 million records, or 85 per cent, now have data in them
• 2.05 billion documents uploaded to My Health Record
• 70 million clinical documents
• 136 million medicine documents
• 1.83 billion Medicare documents
• 97 per cent of pharmacies registered and 78% using
• 92 per cent of GPs registered and 82% using
• 95 per cent of public hospitals registered and 91% using
• The most recent information is available at https://www.myhealthrecord.gov.au/statistics

Media contact

Australian Digital Health Agency Media Team
Mobile: 0428 772 421
Email: media@digitalhealth.gov.au

About the Australian Digital Health Agency

The Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems, and implementing Australia’s National Digital Health Strategy – Safe, Seamless, and Secure: evolving health and care to meet the needs of modern Australia in collaboration with partners across the community. The Agency is the System Operator of My Health Record, and provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system. These improvements will give individuals more control of their health and their health information, and support healthcare providers to deliver informed healthcare through access to current clinical and treatment information. Further information: www.digitalhealth.gov.au

Unusually we are provided with links to the research, but this was not actually contained in the press release! I wonder why?

Here is the entry:

National Digital Health Strategy Research

The Agency commissions its own research and supports researchers to evaluate the delivery of the National Digital Health Strategy.

Recently released research commissioned by the Agency:

13 July 2020 – HCP: digital health understanding and use (PDF, 1,072 KB)
13 July 2020 – Consumers – digital health understanding and use (PDF, 998 KB)

Here is the link:

https://www.digitalhealth.gov.au/about-the-agency/publications/national-digital-health-strategy-research

(I note, in passing, this is the only research on the web site under this category - clearly the Strategy is deeply researched!)

In the first study – which is 9 pages long the questions were:

1. Q: What sort of internet connection do you have in the [INSERT PLACE OF WORK]?

2. Q; To what extent do you agree or disagree with the following  -I am very open to doing more things digitally (e.g. apps, online self-service) for my workplace.

3. Q: To what extent do you agree or disagree with the following - I think it is important that I understand how to use technology to improve health outcomes.

4. Q: To what extent do you agree or disagree with the following -I can see the benefits of mobile technology for my workplace.

5. Q: To what extent do you agree or disagree with the following -I think that it is important for the Government to focus on technology in health.

What can you actually conclude when people say they are ‘open’ to something.

The study was an online survey of a little over 300 professionals from a population which had been recruited for other studies.

That the responses were positive is no surprise indeed the questions were close to the ‘when did you stop beating your wife’ style in seeking a managed response.

The second study from October 2019 ran to a healthy 10 pages.

The title was :  Research to inform digital health understanding.

They ran focus groups in 4 locations of some well and some chronically ill people of differing ages. (SINKs/DINKs also came – what ever they are)

It seemed that few had heard of Digital Health and most seemed to struggle to be sure what it would be good for.

To me this study got nowhere near assessing readiness for adoption and use of Digital Health even if they did not know what it was.

As far as the release is concerned it seems the ADHA sees use of the telephone as Digital Health as this is what has been the main technology that has been adopted in Telehealth – with much less on Skype and Zoom.

Basically the release is exaggeration laden rubbish, with little grounding in reality!

David.

We Now Have Some Numbers Around How Expensive Major Cyber Disruption Could Be.

This appeared last week:

Major cyber attack would be worse than COVID-19

Ronald Mizen Reporter

Jul 13, 2020 – 12.00am

A major cyber offensive against Australia would be far more disruptive on people’s lives than the coronavirus pandemic and lead to widespread distrust of critical systems and services, a new report reveals.

According to AustCyber’s Australia’s Digital Trust Report 2020, a four-week digital disruption, such as a widespread cyber attack, would cost the economy up to $30 billion and 163,000 jobs.

"Full-scale cyber or digital disruption for four weeks has devastating impacts, even though digital activity continues," the report states.

"Before the onset of the COVID-19, contemplating losing 163,000 jobs in one month would likely have been unthinkable.

"However, recent events have shown the extent to which immediate and catastrophic risk is not simply possible, it can occasionally be highly probable."

Digital activity supported 22 per cent of the economy in 2019-20 and directly generated 6 per cent of the national GDP.

AustCyber chief executive Michelle Price said the coronavirus pandemic had further exposed the country to cyber attacks from nation-state actors and cyber-criminals.

“The timing of the release of this report is both critical and deliberate," Ms Price said. "The pandemic caused a rapid move to remote working and education, renewed focus on online business delivery and fast adaptation of supply chains using digital technologies.

“The quality of digitisation and its trustworthiness is now under immense pressure as the economy starts to recover from the pandemic.

More here:

https://www.afr.com/politics/federal/major-cyber-attack-would-be-worse-than-covid-19-20200712-p55ba9

There is more coverage here:

Cyber experts urge Australia to develop local capability to defend against hackers

By Anthony Galloway

July 12, 2020 — 11.40pm

Cyber experts have urged the federal government to become less reliant on overseas businesses, technologies and expertise for its defences against hackers as it puts the finishing touches on the nation's new cyber security strategy.

Foreign providers are responsible for most of the cyber security products and services in Australia, with no local companies among the 15 largest software providers in the local market.

The Sydney Morning Herald and The Age can reveal that the government's panel of industry experts will hand down advice as early as this week urging it to invest in the local cyber industry to boost the nation's defences.

The government has been awaiting the report of the Industry Advisory Panel, chaired by Telstra chief executive Andrew Penn, before finishing its new four-year cyber security strategy. The industry panel's report, expected to urge the government to invest in more training, will be released in the coming weeks, according to senior government sources.

The advice comes after a sophisticated state-based actor, which Australian intelligence agencies believe to be China, launched this year a wave of cyber attacks against all levels of government, industry and political organisations.

Fergus Hanson, director of the International Cyber Policy Centre at the Australian Strategy Policy Institute, said Australia needed to increase its investment in human resources as a first step, while government procurement guidelines setting a minimum level of local content might also be needed.

Mr Hanson said the government should also clearly set out which areas of cyber security it wanted to have a sovereign capability, so the business community could invest in those areas.

"If you are going to mandate certain sectors where you're going to build up sovereign capability, then we should also set up FIRB (Foreign Investment Review Board) guidelines so you don't build up local companies and then they're bought out by foreign adversaries," he said.

The Morrison government has already flagged developing a “sovereign cloud” to hold the data of Australians to protect personal information from overseas governments and companies.

Lots more here:

https://www.smh.com.au/politics/federal/cyber-experts-urge-australia-to-develop-local-capability-to-defend-against-hackers-20200710-p55b1t.html

There are some extra specifics here:

Cyber security ‘needs a new approach’

David Swan

Glenda Korporaal

·         12:00AM July 18, 2020

A government advisory group helping prepare Australia’s 2020 Cyber Security Strategy will publish its recommendations on Tuesday, The Weekend Australian can reveal.

Speaking at a roundtable discussion with the Business Council of Australia, Telstra boss Andy Penn said the panel’s report would include about 60 recommendations to the government, urging it to increase spending in Australia’s cyber security industry.

The industry group chaired by Mr Penn includes Tesla chair Robyn Denholm, former US secretary of homeland security Kirstjen Nielsen, Vocus chair Robert Mansfield, NBN Co chief security officer Darren Kane and others.

It comes weeks after Prime Minister Scott Morrison warned of a sophisticated ongoing cyber attack by a nation state, presumed to be China, affecting “all levels of government”, and just days after it was revealed Russian hackers were behind a campaign to steal data relating to a COVID-19 vaccine.

Lots more here:

https://www.theaustralian.com.au/business/technology/cyber-security-needs-a-new-approach/news-story/0d3d735db7a317e6d3d067f2526b91b7

and there is a specific warning here:

Local COVID-19 vaccine researchers warned of cyber attack threat

By Emma Koehn

July 17, 2020 — 11.45pm

Data security experts are warning Australian researchers working on coronavirus vaccines and treatments to remain vigilant as global hackers try to access their work.

Industry insiders said Australia's world-leading research made it a target for state and non-state actors, with experts warning hackers aren't just looking for vaccine and treatment blueprints, but also for information about supply chain logistics, including plans for vaccine production and information on strategies for procuring supply.

"Researchers are on the front lines: they will be targeted because they are the ones developing new ideas, new capabilities and, in a pandemic, the possible solution," said Professor Lesley Seebeck, chief executive of the Cyber Institute at the Australian National University.

"Australia has research and trials underway that will be of interest to bad actors, both state and non-state."

The warnings come as the US, UK and Canada issued statements on Thursday accusing Russian intelligence of launching cyber attacks on companies working on COVID-19 projects.

More here:

https://www.smh.com.au/business/small-business/local-covid-19-vaccine-researchers-warned-of-cyber-attack-threat-20200717-p55czb.html

So there is a lot going on and the risks, and potential costs, are really on the rise. Seems like quality specialist training in the area my be a very sensible career choice – despite AI doing an increasing amount of the grunt work!

David.