Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, November 12, 2022

Weekly Overseas Health IT Links – 12th November, 2022.

Here are a few I came across last week.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment

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https://ehrintelligence.com/news/ostp-onc-seek-input-on-optimizing-clinical-trial-electronic-data-capture

OSTP, ONC Seek Input on Optimizing Clinical Trial Electronic Data Capture

To work towards a national clinical trials enterprise, OSTP and ONC seek input on using HL7 FHIR-based application programming interfaces (APIs) for clinical trial data capture.  

By Hannah Nelson

November 04, 2022 - The White House Office of Science & Technology Policy (OSTP), in coordination with the National Security Council, issued a Request for Information (RFI) on October 26, seeking input on optimizing electronic data capture for clinical trials.

COVID-19 emphasized the need for a national clinical trials enterprise. In response, the Biden-Harris Administration released the National Biodefense Strategy, which calls for a clinical trial infrastructure “ready to administer candidate countermeasures to participants within 14 days after the identification of a viable countermeasure.”

“A key component in building US capacity for clinical research – both during a public health threat and at other times – is ensuring that trial data can be captured as a set of consistent data elements across separate trial sites under a coordinated clinical trial protocol,” OTSP and ONC officials wrote in a HealthITBuzz blog post.

“Currently, researchers must analyze different datasets, developed under different research protocols, stored in different formats, in data repositories that are often not accessible to all participants. This delays the development of evidence,” they added.

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https://www.digitalhealth.net/2022/11/nhs-report-calls-for-artificial-intelligence-training-for-all-staff

NHS report calls for artificial intelligence training for all staff 

A new report published by the NHS AI Lab and Health Education England (HEE) is calling for all health and care staff to receive training in artificial intelligence (AI). 

Cora Lydon – 2 Nov 2022

The Developing healthcare workers’ confidence in AI report also advises that staff working with AI tools in clinical practice should receive additional specialist training.  

AI technology is already being used within the NHS and it is likely that its use will become even more widespread. The report states: “At a strategic level, the report can inform how Health Education England, educational and training providers and educators of healthcare workers plan, resource, develop and deliver educational offerings to equip the workforce with necessary knowledge, skills and capabilities.” 

The report is the second from the NHS AI Lab looking at the topic of AI skills for staff. The first, Understanding healthcare workers’ confidence in AI, recommended that educational pathways and materials should be deployed to support healthcare professionals at all career points to confidently evaluate, adopt and use AI. The most recent report focuses on identifying the key educational requirements to equip the NHS workforce with confidence in AI tech. 

Both reports come in light of the Topol Review which recommended the NHS should focus on building a digital-ready workforce.  

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https://www.digitalhealth.net/2022/11/the-kings-fund-interoperability-report

The King’s Fund interoperability report highlights relationships and technology

A recent report by The King’s Fund has highlighted the importance of strong relationships and functioning technology for interoperability to progress in an integrated care system (ICS) setting.

Jordan Sollof 3 Nov 2022

Following analysis of existing literature and a combination of interviews and workshops with staff in the health and care system and national bodies, The King’s Fund concluded that interoperability has three important aspects that are vital for success.

These are good co-working relationships between staff, technology that makes co-working as easy as possible, and an enabling environment in which funding, capacity, skills, education and governance are aligned.

The value of strong relationships and working culture

The report, titled ‘Interoperability is more than technology: The role of culture and leadership in joined-up care’, explains that relationships and working culture are essential aspects to get right for interoperability to progress in ICSs.

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https://www.webmd.com/fitness-exercise/news/20221103/smartphone-data-may-predict-mortality-risk

Dead Man Walking? Smartphone Data May Predict Mortality Risk

Written by Lindsey Leake

Nov. 3, 2022 -- Maybe you’re on a leisurely neighborhood stroll or roaming the aisles of a grocery store. Chances are, your smartphone’s along for the trip, too — perhaps as a podcast player or a digital security blanket. 

But what if that phone could gather data from your everyday cardio activities to predict how long you’ll live?

There may not be an app for that just yet, but researchers from the University of Illinois laid the groundwork for the possibility in a study published recently in the journal PLOS Digital Health.

“It’s well known that people [who] move more — and move more vigorously — live longer,” says Bruce Schatz, PhD, an expert in medical informatics at the University of Illinois and a co-author of the study. “We ended up trying to see what you could tell from walking motion that had some medical significance.”

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https://ehrintelligence.com/features/how-ehr-innovation-platforms-cut-clinician-burnout-for-value-based-care

How EHR Innovation Platforms Cut Clinician Burnout for Value-Based Care

An AAFP study found that EHR innovation platforms helped reduce clinician burnout by improving EHR integration and documentation workflows for value-based care models.

Hannah Nelson

Assistant Editor

November 03, 2022 - EHR innovation platforms that complement value-based care models could help address clinician burnout, according to preliminary findings from an American Academy of Family Physicians (AAFP) Innovation Laboratory study.

While clinician burnout is a concern across the healthcare industry, it is especially high among family medicine clinicians. Half of family physicians report one symptom of burnout, according to 2020 research.

"We're seeing folks decide that maybe medicine or primary care is not right for them any longer, or they're discouraging colleagues or their children from going into the specialty," Steven Waldren, MD, MS, AAFP vice president and chief medical informatics officer, told EHRIntelligence in an interview.

The administrative burden associated with EHR documentation is one of the main drivers of clinician burnout, Waldren said.

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https://ehrintelligence.com/news/chime-recognizes-18-healthcare-orgs-as-2022-digital-health-most-wired

CHIME Recognizes 18 Healthcare Orgs as 2022 Digital Health Most Wired

Despite the COVID-19 pandemic, the CHIME Digital Health Most Wired survey grew by 20 percent in 2022 and represents over healthcare facilities from 10 countries.

By Hannah Nelson

November 03, 2022 - The College of Healthcare Information Management Executives (CHIME) has awarded 18 healthcare organizations the highest level of the CHIME Digital Health Most Wired Survey with level 10 certification for their commitment to digital health transformation.  

To be certified at level 10, organizations must demonstrate an outstanding record of leveraging health IT within a visionary corporate strategy.

“We are excited to recognize those in the forefront of digital excellence,” H. Stephen Lieber, chief analytics officer at CHIME, noted in a press release. “Their pioneering performance inspires other organizations by example.”

“Patients in communities around the world receive better care because these providers drive change through digital transformation, as they have proven through their success in this rigorous survey,” Lieber continued.

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https://healthitanalytics.com/news/use-of-ai-enabled-screening-tool-led-to-more-diagnoses-of-heart-condition

Use of AI-Enabled Screening Tool Led to More Diagnoses of Heart Condition

New research from Mayo Clinic found that using an artificial intelligence-enabled screening tool led to more diagnoses of low left ventricular ejection fraction.

By Mark Melchionna

November 03, 2022 - A recent Mayo Clinic study found that the use of an artificial intelligence (AI)-enabled screening tool displayed the ability to assist providers while diagnosing low left ventricular ejection fraction, with high adopters of the technology diagnosing the heart condition more frequently than those who did not use the tool.

According to the Centers for Disease Control and Prevention (CDC), about 6.2 million adults in the US experience heart failure, which occurs when the heart cannot pump enough blood and oxygen to support organs in the body. Low left ventricular ejection fraction is a heart condition where the percentage of blood that pumps out of the heart is low. The condition can be caused by the weakening of heart muscles, issues related to heart valves, uncontrolled blood pressure, or damage that results from a heart attack.

According to the press release, Mayo Clinic researchers acknowledged that early diagnosis is highly beneficial when addressing this condition, as it can lead to a lower risk of heart failure and mortality. This led them to experiment with the use of an AI-enabled tool.

"AI decision support tools have the potential to be very effective in aiding the diagnosis of serious health conditions before the onset of usual clinical symptoms, and may outperform traditional diagnostic approaches," said David Rushlow, MD, a Mayo Clinic physician and chair of family medicine for Mayo Clinic in the Midwest, in a press release.

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https://healthitsecurity.com/news/cisa-fbi-ms-isac-provide-guidelines-for-ddos-incident-response

CISA, FBI, MS-ISAC Provide Guidelines For DDoS Incident Response

CISA, the FBI, and MS-ISAC offered several response procedures that federal and private agencies should take to prevent and remediate a DDoS attack.

By Sarai Rodriguez

November 03, 2022 - The Cybersecurity and Infrastructure Security Agency (CISA), alongside the Federal Bureau of Investigation (FBI) and the Multi-State Information Sharing and Analysis Center (MS-ISAC), released a joint guide containing recommended procedures to reduce the likelihood and impact of distributed denial-of-service (DDoS) incidences.

A standard denial-of-service (DoS) is a type of cyberattack that occurs when threat actors exhaust a system’s network server, making the system unavailable to the intended users.

DDoS attacks have increased in popularity as more IoT devices come online. IoT devices often have shaky IT security postures, and attackers can easily compromise them.

A DDoS attack occurs when the overloading traffic originates from more than one attacking machine. Typically threat actors will leverage botnets—a group of hijacked devices connected over the internet— to carry out large-scale attacks that appear to originate from multiple networks.

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https://www.fiercebiotech.com/medtech/evidation-launches-digital-flu-monitoring-program-tracking-steps-find-infections

Evidation launches digital flu monitoring program, tracking steps to find infections

By Conor Hale

Oct 31, 2022 11:57am

The health data company Evidation is launching a monitoring program to track potential cases of influenza, as the U.S. and northern hemisphere prepares for a particularly early and aggressive flu season. 

The company aims to cast a digital net to catch signs of the disease by collecting information from wearable devices and self-reported symptoms. Using machine learning algorithms, the FluSmart program will inform participating users when early changes in their activity levels may correspond with an oncoming infection.

“We have been studying and characterizing influenza-like illness using wearables since 2017, and FluSmart makes this expertise actionable for individuals,” Christine Lemke, Evidation’s co-founder and co-CEO, said in a release. The company said that more than 90,000 people have signed up for the program so far through the Evidation app.

Earlier this year, the former Fierce 15 honoree published a study that took a closer look at step-tracker data minute-by-minute from more than 15,000 people who reported flu-like symptoms during the 2018-2019 season, before the onset of the COVID-19 pandemic. The study’s primary aim was to track the number of steps lost during the four days leading up to the onset of symptoms and then followed changes in the user’s activity for 11 days after that. 

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https://www.fiercebiotech.com/medtech/biointellisense-launches-skin-tone-agnostic-pulse-oximetry-sensor-fda-meets-racial-bias

BioIntelliSense launches skin tone-sensitive pulse oximetry sensor as FDA meets on racial bias

By Andrea Park

Nov 1, 2022 12:19pm

As the FDA convenes an advisory committee meeting to discuss recent studies showing that many pulse oximeters are less effective when used on patients with darker skin, BioIntelliSense is getting a head start on addressing the issue.

The devicemaker unveiled a new pulse oximetry sensor chipset on Tuesday, just a few hours before the scheduled start time of the virtual FDA meeting—in which BioIntelliSense was also slated to participate.

Most pulse oximeters emit red and infrared light through the skin on a patient’s finger, then analyze how that light is shifted by the patient’s blood to calculate the percentage of oxygen in their red blood cells. BioIntelliSense’s version, however, adds a white light and spectral sensor that allow it to automatically adapt to different skin pigmentation.

According to BioIntelliSense, the system continuously adjusts the amount of light emitted based on its absorption by the skin to ensure the blood cells are being illuminated at equal levels; darker skin tones have been found to absorb more light before it can reach the tissue.

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https://www.healio.com/news/orthopedics/20221101/telehealth-physical-therapy-associated-with-decreased-utilization-patient-satisfaction

November 01, 2022

By Max R. Wursta

Telehealth physical therapy associated with decreased utilization, patient satisfaction

Results showed a significant reduction in the use of telehealth physical therapy visits for sports injuries from 2020 to 2021, with patients who had telehealth reporting lower patient satisfaction scores than those who had in-person visits.

In a cross-sectional study, Billy I. Kim, BA, and colleagues from Duke University analyzed 59,461 in-person and 2,016 telehealth physical therapy (PT) visits from March 1, 2020, to Dec. 31, 2021. All patients were referred from an orthopedic sports medicine clinic.

Researchers found telehealth PT utilization decreased from 1,676 visits in 2020 to 340 visits in 2021, while in-person PT utilization increased from 22,586 visits in 2020 to 37,055 visits in 2021.

After review of the 1,012 completed patient surveys, Kim and colleagues found 75% of telehealth patients and 89.1% of in-person patients were likely to recommend their encounter to others, while 71.7% of telehealth patients and 88.6% of in-person patients rated their overall visit as the top-box score. Researchers also noted telehealth users were more often female, English-speaking, in the lowest quartile for median household income, had Medicare insurance carriers, were living out-of-county or living in nonurban areas.

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https://www.healthleadersmedia.com/technology/hospitals-turn-technology-bridge-communication-barrier

Hospitals Turn to Technology to Bridge the Communication Barrier

Analysis  |  By Eric Wicklund  |   November 03, 2022

Healthcare organizations are using digital health technology to help doctors and nurses communicate with patients who speak different languages, aren't comfortable using English, or have other communication challenges. 


KEY TAKEAWAYS

·         Healthcare organizations are increasingly facing challenges communicating with patients who speak another language, don't fully understand English, or have cognitive issues that affect communication.

·         This communication barrier not only hinders providers from understanding a patient's health concern, but could also affect how a patient understands a diagnosis or treatment plan.

·         A new wave of innovation aims to address this challenge through apps and platforms that link providers in real time to qualified medical interpreters, as well as robots, wearables, and other technology aimed at helping people communicate.

With more than 800 languages spoken in the New York City area, communication challenges are a very real possibility. And nowhere is that more dangerous than in a healthcare facility, where an incorrect translation could affect clinical outcomes.

Healthcare organizations are turning to technology to address that challenge, with partnerships and digital health platforms that enable care teams to access interpreters in real time.

"We deal with a melting pot as far as diversity goes," says Kerry Donohue, MSN, RN, manager of patient experience and culture leader at Manhattan Eye, Ear, and Throat Hospital (MEETH), a division of Northwell Health's Lenox Hill Hospital. "Every day, I'd say one out of every five patients [speaks a language other than English}, and it can be challenging."

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https://ehrintelligence.com/news/noaa-may-join-federal-ehrm-program-to-deploy-oracle-cerner-ehr-system

NOAA May Join Federal EHRM Program to Deploy Oracle Cerner EHR System

NOAA plans to deploy the Oracle Cerner EHR platform as part of the Federal EHRM program, joining an integrated system that aligns with the VA, DOD, and the US Coast Guard.

By Sarai Rodriguez

November 02, 2022 - The Federal Electronic Health Record Modernization (FEHRM) program’s ongoing effort to deploy the Oracle Cerner EHR system across federal agencies may now include The National Oceanic and Atmospheric Administration (NOAA), according to reporting from FedScoop.

If the anticipated EHR implementation, targeted for summer 2023, goes successfully, NOAA will be connected to the Department of Veterans Affairs (VA), Defense (DOD), and Homeland Security’s US Coast Guard (USCG) through a single, common EHR.

“The mission for EHRM – the vision really – is for each veteran to have a comprehensive health record that is accessible across the Department of Veterans Affairs, DoD [Department of Defense], US Coast Guard, and communicate [to] providers,” Laura Prietula, the deputy chief information officer (CIO) for the EHRM program, said during an FCW event.

“This will enhance the quality of their health care – and soon we’re probably going to also have another Federal agency joining us,” Prietula implied.

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https://ehrintelligence.com/news/how-adding-biometric-data-to-the-ehr-can-drive-patient-matching

How Adding Biometric Data to the EHR Can Drive Patient Matching

Including biometric data like facial imaging in the EHR could help improve patient matching and cut costs, but patient data security remains a concern.

By Hannah Nelson

November 02, 2022 - Adding biometric data to the EHR can enhance patient matching, but it presents unique data security challenges, according to a Pew Charitable Trusts report

Patient health data is often spread across several EHRs from doctors' offices, hospitals, and health systems. Healthcare providers must match those files to get a complete picture of their patients' health history, but errors in matching records to the correct patient are common.

According to a 2012 survey, nearly one in five hospital CIOs indicated patient harm in the previous year due to record mismatches. These kinds of errors cost the healthcare system about $6 billion annually.

RTI International, a nonprofit research institute, and The Pew Charitable Trusts conducted 12 interviews between April and July 2020 to identify how biometrics could enhance patient matching.

The researchers then held work group discussions with 29 experts from health systems, insurers, biometric and digital identity technology developers, health information exchange (HIE) platforms, EHR vendors, patient and privacy advocates, health policy advisers, standards organizations, and ONC.

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https://mhealthintelligence.com/news/most-americans-find-virtual-primary-care-effective-appealing

Most Americans Find Virtual Primary Care Effective, Appealing

New survey results show that 79 percent of Americans who engaged in virtual primary care stated that it allowed them to take charge of their health.

By Mark Melchionna

November 02, 2022 - Recent survey results released by Elevance Health found that most Americans who participated in virtual primary care said their experience was satisfactory and that the service effectively enabled them to manage their health.

Formerly known as Anthem Inc., Elevance Health is a health insurer. Through the survey, Elevance aimed to gather data on virtual primary care, its outcomes, and what patients think. The payer commissioned the Harris Poll to conduct an online survey of more than 5,000 US adults aged 18 and over.

Researchers found that 79 percent of study participants believed virtual primary care allowed them to take charge of their health, and 94 percent were satisfied with their experience.

“Consumers are using digital technologies at an accelerating pace, and consistent with this, we’re seeing at Elevance Health use of telehealth that is nearly 20 times greater than pre-pandemic levels,” said Rajeev Ronanki, president of digital platforms at Elevance Health, in a press release. “Virtual primary care gives individuals the opportunity to work with innovative services that make healthcare more convenient, accessible, and fit into their increasingly busy schedules. The study’s findings reiterate the desires of consumers to use digital technology – along with using traditional in-person care options – to take control of their health.”

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https://patientengagementhit.com/news/only-1-of-docs-use-patient-reported-outcomes-measures-proms

Only 1% of Docs Use Patient-Reported Outcomes Measures (PROMs)

Despite a nearly 60 percent baseline patient-reported outcomes measures (PROMs) response rate, only 1 percent of clinicians use PROMs in clinical workflows.

By Sara Heath

November 02, 2022 - The healthcare industry is making significant headway in collecting patient-reported outcomes measures (PROMs), but clinicians are making little use of that data, limiting enhancements in patient experiences of clinical treatment, researchers wrote in the American Journal of Medical Quality.

Future studies should look into the barriers to using PROMs in clinical care, the researchers said.

PROMs are important clinical quality measures for certain types of medical interventions or treatments. Unlike many typical clinical quality measures, like hospital readmission rates, PROMs look at the patient perspective of care and measure whether an intervention effectively addressed medical needs or improved functional status.

In an orthopedic setting, for example, PROMs can help clinicians determine whether interventions like joint replacements helped patients live better or more fulfilling lives. PROMs might ask patients how they are feeling, whether they can comfortably move around their homes, and if they can complete certain tasks of daily living.

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https://www.medicaleconomics.com/view/the-data-dilemma

The Data Dilemma

November 1, 2022

Jeffrey Bendix

Medical Economics Journal, Medical Economics November 2022, Volume 99, Issue 11

Digitizing patient health data was supposed to make it usable for public and population health research. So far, that hasn’t happened.

Between 2011 and 2015 the government spent upwards of $35 billion subsidizing doctors’ purchases of electronic health records (EHRs) through the Meaningful Use program. It did so mainly in the expectation that EHRs would enable doctors to provide better care for patients and streamline practice and hospital workflows.

But the 2009 Health Information Technology for Clinical Health (HITECH) Act — the law that spawned Meaningful Use — included an additional motive for encouraging EHR use: advancing public and population health. The hope was that digitizing millions of patient health records would produce a treasure-trove of data that researchers could mine for purposes such as spotting disease outbreaks and developing new ways of treating chronic conditions.

Seven years after Meaningful Use, and three years into the COVID-19 public health crisis that has claimed more than a million lives, it’s evident that the hoped-for public/population health benefits of EHRs remain unfulfilled. That raises the questions, why haven’t those hopes been realized? Will they ever be? And were the public/population uses of EHRs oversold?

“We invested $35 billion and just went through a pandemic where we didn’t have enough information to answer the public’s questions about what we should do,” says Shannon West, chief information officer at the health data consulting firm Datavant and former chief technology officer at the Center for Medicare and Medicaid Innovation (CMMI). “And as taxpayers I think we should all be asking, ‘why isn’t this working?’”

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https://www.healthleadersmedia.com/technology/social-determinants-health-measures-baked-ehr-are-improving-patient-care

Social Determinants of Health Measures, Baked into the EHR, Are Improving Patient Care

Analysis  |  By Scott Mace  |   November 02, 2022

The Memorial Healthcare System is focusing on food, housing, and transportation to help reduce unnecessary ED visits and boost care quality.


KEY TAKEAWAYS

·         A shadow schedule enables same-day walk-in or telehealth appointments, decreasing no-shows and ED overuse.

·         Social determinants of health, captured by staff through the Epic EHR, end up populating problem lists, putting those factors in front of doctors with minimal extra work for physicians.

·         The health system generates automated in-baskets to connect patients with resources for needed social services.

A Florida health system is putting social determinants of health (SDOH) right into the electronic health record problem list, where doctors can see and act on them.

Spearheading this initiative is Jennifer Goldman, DO, chief of Memorial Primary Care at the six-hospital Memorial Healthcare System, based in Hollywood, Florida. In this interview with HealthLeaders, Goldman explains how SDOH is embedded in the EHR and used to improve outcomes. This interview has been lightly edited for brevity and clarity.

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https://www.fiercehealthcare.com/payers/podnosis-data-privacy-and-what-you-missed-digital-pharma-east-conference

'Podnosis': Sizing up data privacy legislation and what you missed from the Digital Pharma East conference

By Teresa Carey

Nov 2, 2022 06:00am

The American Data Privacy and Protection Act says it would protect “any information that describes or reveals the past, present or future physical health, mental health, disability, diagnosis or healthcare treatment of an individual.” The bill, introduced in July, comes at a time when more tech companies are breaking into the healthcare space and eyes are turning to the protection of reproductive health data. To gain insight into the bill’s uncertain future, Fierce’s Annie Burky spoke with Deven McGraw, lead of data stewardship and sharing at medical genetics company Invitae.

And listen in on a snippet from a panel senior editor Heather Landi moderated at Digital Pharma East on leveraging digital health tools and social determinants data to improve patients’ health.

To learn more about topics in this episode: 

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https://www.healthdatamanagement.com/articles/onc-hl7-industry-groups-seek-participants-for-sdoh-data-exchange-pilot-in-real-world-setting?id=131645

ONC, HL7, industry groups seek participants for SDOH data exchange pilot in real-world setting

The national Gravity Project Pilots Affinity Group intends to pilot and test a SDOH clinical care FHIR Implementation Guide to expand use of social factors in healthcare.

Oct 31 2022

HDM Staff

A new workgroup is looking to create and test an implementation guide that would advance the development and adoption of standards for social determinants of health.

The group’s membership includes Health Level 7, the Office of the National Coordinator for Health Information Technology and other partners. Called the Gravity Project Pilots Affinity Group, the initiative seeks to combine efforts to demonstrate how best to enable the nation’s technical infrastructure to enable interoperability of SDOH data.

ONC detailed its role in the Gravity Project Pilot group in a blog post released on October 27.

Partners in the workgroup also include IHE, AARP and “a wide range of partners from healthcare, government (federal and states), community-based organizations, developers, providers and industry stakeholders,” the blog notes. It’s seeking to create a SDOH Clinical Care FHIR Implementation Guide.

“Additionally, ONC is supporting the publication of the latest version of the SDOH CC IG currently in ballot and providing funding for sites to pilot the SDOH CC IG,” the ONC blog notes.

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https://www.healthcareitnews.com/news/concern-cybersecurity-workforce-mental-health-rising

Concern for cybersecurity workforce mental health is rising

Burnout rates in cybersecurity may be exceeding those among frontline healthcare workers. The call to bolster resilience among cyber professional is loud and clear, says Cybermindz.

By Andrea Fox

November 02, 2022 04:08 PM

On National Stress Awareness Day 2022, it wouldn't be a stretch of the imagination to consider that healthcare cybersecurity professionals are experiencing higher than normal stress and may face elevated risks to their mental health.

There's the stress caused by a continuous threat of attacks currently weighing significantly on the whole cybersecurity workforce. Preliminary results of research on burnout among cyber professionals by the Australia-based mental wellbeing support organization Cybermindz, announced this week, point to a worrying trend, says Dr. Andrew Reeves, the group's director of organizational and behavioral research, who is leading the study.

He explained in the research update that on the key burnout metric of professional efficacy, the cyber professionals surveyed so far have scored significantly worse than the general population. 

"We also compared their rates of burnout on this metric to another highly burnt-out industry: that of frontline healthcare workers, and found that the cyber professionals score considerably lower than even this group on this metric," he added.

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https://healthitsecurity.com/news/ocr-releases-video-on-recognized-security-practices-under-hitech

OCR Releases Video On Recognized Security Practices Under HITECH

OCR created the video presentation to educate covered entities and answer common questions about recognized security practices under HITECH.

By Jill McKeon

November 01, 2022 - The HHS Office for Civil Rights (OCR) released an educational video presentation on recognized security practices (RSPs) under HITECH. Nick Heesters, senior advisor for cybersecurity at OCR, presented the video and addressed key industry questions about implementation and liability.

In January 2021, Congress enacted an amendment to the HITECH Act “to require the Secretary of Health and Human Services to consider certain recognized security practices of covered entities and business associates when making certain determinations, and for other purposes.”

The amendment directed covered entities to implement security controls based on either the National Institute of Standards and Technology (NIST) framework, section 405(d) of the Cybersecurity Act of 2015, or other “programs that address cybersecurity recognized by statute or regulation.”

Under the statute, OCR is required to take a covered entity’s recognized security practice implementation from the past 12 months into account when conducting Security Rule audit and enforcement activities.

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https://www.healio.com/news/primary-care/20221031/automated-messaging-system-may-reduce-acute-care-resource-usage-after-hospital-discharge

October 31, 2022

Automated messaging system may reduce acute care resource usage after hospital discharge

ByAndrew Rhoades

Automated text-messaging systems supporting primary care patients following hospital discharge were associated with reductions in the use of acute care resources, a study found.

Noting the criticalness of post-discharge periods, Eric Bressman, MD, MSHP, a fellow in the National Clinician Scholars Program at the University of Pennsylvania, and colleagues wrote in JAMA Network Open that a commonly utilized post-discharge care management approach has been “a single primary care–based, nurse-led telephone call to identify needs shortly after discharge.”

“This approach has proven effective in some settings in reducing unplanned readmissions; however, the calls are limited in scope and present a significant operational burden,” they wrote. “In our experience, the calls can be time intensive, often go unanswered and generally connect with patients only once, early in the course of their recovery.”

Looking to improve upon these limitations, the researchers developed a 30-day intervention based on an automated text-messaging system with two-way capability.

Bressman and colleagues implemented the system in a primary care practice from Jan. 27, 2021, to Aug. 27, 2021. Patients who used it received automated check-in text messages from the practice on a tapering schedule after discharge. Staff members used an electronic medical record inbox to follow up with patients who had any needs that were identified by the automated messaging platform. The outcomes of patients in the intervention group were compared with those of a control group.

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https://www.forbes.com/sites/meimeifox/2022/10/31/how-unicorn-startup-forward-aims-to-revolutionize-healthcare/?sh=75e28bf4277f

Forbes Women

How Unicorn Startup Forward Aims To Revolutionize Healthcare

Oct 31, 2022,08:30am EDT

MeiMei Fox

Most of us realize that America’s current healthcare system is broken. According to the CDC, approximately one in three people die early from a preventable disease such as cancer, heart attack, and stroke. Then there is the issue of medical debt, a burden that impacts one in ten Americans. Finally, the way insurance is tied to employment in this country creates real problems. On average, Americans change their insurance every four years, which incentivizes companies to substantially increase premiums and restrict doctors from providing preventative care for serious diseases or engage in meaningful relationships with their patients.

The cofounders of Forward Heath, Adrian Aoun and Rob Sebastian, want to overhaul healthcare in America – and eventually the world – from the ground up. The two Google veterans are on a mission no less ambitious than “to bring affordable and accessible healthcare to billions of people.”

Named a unicorn in 2021 with a Series D round of $225 million, Forward harnesses the power of technology to deliver personalized healthcare without insurance. The company’s high-profile investors include Salesforce co-founder Marc Benioff, recording artist The Weeknd, Uber cofounder Garrett Camp, and former Google CEO Eric Schmidt, among others. Offices exist so far in 25 cities across ten states and Washington, D.C., with many more locations opening soon.

In its effort to completely alter the way healthcare works, Forward operates on a subscription model. Rather than paying for health insurance, customers pay a flat monthly fee. The company believes this methodology has several benefits.

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https://www.healthcareitnews.com/blog/grand-challenges-and-opportunities-patient-centered-cds

Grand challenges and opportunities for patient-centered CDS

AHRQ is helping the transition towards evidence-based recommendations to guide clinical decision-making that incorporates patients' needs and preferences.

By Dr. Prashila Dullabh

November 01, 2022 04:41 PM

Dr. Prashila Dullabh is vice president and senior fellow at NORC at the University of Chicago, and Director of NORC’s Health Implementation Science Center. She serves as the Principal Investigator of the Clinical Decision Support Innovation Collaborative Project.

She co-authored this article with Dean Sittig, NORC senior fellow and professor of biomedical informatics at the University of Texas Health Sciences Center and a co-investigator of the CDSiC Project; Dr. David Lobach, vice president of health informatics research at Elimu Informatics and a co-investigator of the CDSiC Project; James Swiger, health scientist administrator in the division of digital healthcare research in the Center for Evidence and Practice Improvement at the Agency for Healthcare Research and Quality; and Dr. Edwin Lomotan, chief of clinical informatics for the Division of Digital Healthcare Research in the Center for Evidence and Practice Improvement at AHRQ. 

Providing patient-centered, equitable and evidence-based health care is increasingly recognized as a goal the U.S. healthcare system needs to aspire to and is working towards. Thanks in part to the Department of Health and Human Services, Agency of Healthcare Research and Quality’s efforts, the US healthcare system is transitioning towards being able to provide patients, caregivers and their care teams access to evidence-based recommendations to guide clinical decision-making that incorporates patient needs and preferences. 

Since 2016, AHRQ has funded a series of projects focused on defining, refining and improving the uptake of patient-centered outcomes research through technology-enabled clinical decision support tools.  

In this Viewpoint we encapsulate the challenges and opportunities facing patient-centered CDS, or PC CDS, by highlighting key findings from the Journal of the American Medical Informatics Association: Challenges and Opportunities for Advancing Patient-Centered Clinical Decision Support: Findings from a Horizon Scan. [1]

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https://www.healthleadersmedia.com/technology/chime-backs-effort-protect-patient-data-mhealth-apps

CHIME Backs Effort to Protect Patient Data in mHealth Apps

Analysis  |  By Scott Mace  |   November 01, 2022

The Federal Trade Commission is weighing options to respond to health data winding up in the wrong hands.

Companies receiving healthcare data through avenues like mHealth applications on mobile devices should be regulated further, according to a trade association of healthcare CIOs.

The College of Healthcare Information Management Executives (CHIME) has submitted comments in response to the Federal Trade Commission's August 11 advance notice of proposed rulemaking. A 60-day public comment period followed the notice's publication in the Federal Register.

"A recent estimate by IQVIA Institute for Human Data Science pegged the number of health-related apps at 350,000," Russell P. Branzell, president and CEO of CHIME, said in the organization's letter to the FTC. "Given the explosion in mobile apps and data aggregation practices, it is entirely possible that the amount of health data held by entities who are not required to comply with HIPAA exceeds the data held by those who are HIPAA-covered entities, certainly a concerning development."

The FTC is seeking comments on whether it should implement new trade regulation rules or other regulatory alternatives concerning the ways in which companies collect, aggregate, protect, use, analyze, and retain consumer data, as well as how they transfer, share, sell, or otherwise monetize that data in ways that are unfair or deceptive.

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https://ehrintelligence.com/news/fehrm-hits-milestone-with-half-of-mhs-providers-using-oracle-cerner-ehr

FEHRM Hits Milestone With Half of MHS Providers Using Oracle Cerner EHR

While VA has delayed upcoming Oracle Cerner EHR implementations until June 2023, the Defense Health Agency is progressing on the FEHRM project.

By Hannah Nelson

October 31, 2022 - The Defense Health Agency implemented the federal Oracle Cerner EHR system to 18 more military hospital and clinic commands on September 24 as part of the Federal EHR Modernization (FEHRM) project, according to reporting from Health.mil.

More than half of all Military Health System (MHS) providers are now using the EHR system, MHS GENESIS, which is the centerpiece of a larger transformation to standardize, integrate, and manage health data across the DoD and the Department of Veterans Affairs (VA).

"This is a significant milestone for the single, common, federal EHR, and I couldn't be more excited on where the federal EHR will take us," Bill Tinston, director of the Federal Electronic Health Record Modernization Office, told the news outlet.

"We know the technology works," Tinston added. "Our partnership with the Department of Defense, the Department of Veterans Affairs, and the US Coast Guard in deploying the federal EHR is enhancing the patient and provider experience."

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https://ehrintelligence.com/news/how-sex-gender-ehr-interoperability-can-drive-population-health

How Sex/Gender EHR Interoperability Can Drive Population Health

Greater interoperability of sex/gender EHR data could help population health researchers support health equity for gender-marginalized patients.

By Hannah Nelson

October 31, 2022 - Interoperability of sex/gender EHR elements could help support research to improve population health, according to a study published in JAMIA.

Researchers examined recommendations from the National Academies of Sciences, Engineering, and Medicine (NASEM) report “Measuring Sex, Gender Identity, and Sexual Orientation” and the Health Level 7 (HL7) Gender Harmony Project (GHP) product brief “Gender Harmony—Modeling Sex and Gender Representation, Release 1.”

“Both the HL7 GHP and the NASEM report agree on several fundamental principles: sex and gender are complex, multidimensional constructs that are essential for improving health at both the individual and population levels,” the researchers wrote.

“In particular, these constructs can help provide better care for transgender and cisgender patients and populations, and they can serve as a bridge between public health and healthcare settings, allowing for disparities and inequities to be identified at the broader population level and addressed at the individual patient level,” they added.

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https://www.fiercehealthcare.com/health-tech/youtube-health-inviting-medical-professionals-apply-health-product-features-boosting

YouTube Health invites medical professionals to apply for health product features boosting visibility, credibility

By Annie Burky

Oct 28, 2022 04:25pm

YouTube Health has unlocked a new door for health professionals to bring high quality health information into the homes of patients.

Medical professionals can now apply to make their videos eligible for the popular video-sharing app’s health product features, which were launched last year and were previously only available to educational institutions, public health departments, hospitals and government entities.

Licensed doctors, nurses, mental health professionals and healthcare information providers must show that their content follows best practices for health information sharing as determined by the Council of Medical Specialty Societies (CMSS), the National Academy of Medicine (NAM) and the World Health Organization (WHO) and have a channel in good standing on YouTube. Approved channels will receive a health source information panel to confirm their medical credibility, and their videos will appear in search results for health content.

“It’s important that information be not just credible but engaging at the same time,” Garth Graham, M.D., director and global head of healthcare and public health at YouTube, told Fierce Healthcare. “Healthcare is still at the point where we're distributing information to patients in flyers and pamphlets and even billboards. I would say those days are becoming more antiquated in terms of healthcare communication; people are looking for information as part of their daily journey. They're looking for it to show up on their phone at the time they have questions looking for answers. So it’s important for us to evolve that communication to where people are.”

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https://www.statnews.com/2022/10/31/hospitals-website-accessibility-needs-work/

Hospitals need to make their websites as accessible as their physical spaces

By Amanda Krupa, Jill B. Roark and Kirsten Barrett

Oct. 31, 2022

It would be anathema for a health care facility in the U.S. to have a main entrance that’s not physically accessible to all people. Yet many of their digital front doors block people with disabilities. They need to change that.

More than 30 years after the Americans with Disabilities Act was signed into law with the aim of removing obstacles to people who are blind, deaf, or have other physical or mental disabilities, the digital landscape continues to erect barriers to access. An investigation by Kaiser Health News in 2021 showed that nearly all of the Covid-19 vaccine registration websites reviewed weren’t accessible to people who are blind, a major violation of disability rights laws in the middle of a public health emergency.

Digital accessibility involves designing webpages to be inclusive of people who have visual, motor, auditory, speech, or cognitive disabilities. More than 61 million people in the United States — nearly 1 in 4 Americans — and more than 1 billion people worldwide have one of these disabilities, including 46% of people age 60 and older. With the number of Americans 65 and older projected to nearly double from 52 million in 2018 to 95 million by 2060, federal officials have already identified the accessibility of online health information as an urgent need.

An issue brief we wrote on behalf of the American Health Information Management Association (AHIMA) Foundation and Mathematica shines a new light on how difficult it can be for people with disabilities to navigate the health care system. Our research found that among 106 top hospitals in the U.S., most of their homepages — their digital front doors — are not accessible to users with disabilities and older users.

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https://www.peoplemanagement.co.uk/article/1803078/cybersecurity-incident-cause-disciplinary

Is a cybersecurity incident cause for a disciplinary?

Salvatore Anania outlines what employers should do if a member of staff enables a cyber attack

by Salvatore Anania 25 October 2022

When it comes to cybersecurity in the workplace, both employers and employees have obligations.

It is the employee’s responsibility to comply with the company’s policies, to understand their role and responsibilities in handling data and appropriately dealing with data breaches and cybersecurity incidents.

Conversely, it is the employer’s responsibility to ensure they have an updated data protection and cybersecurity policy in place and a refreshed data protection and cybersecurity training program that reflects current working patterns, the new vulnerabilities exposed by new technologies, and ways of spotting and preventing cyber-attacks.

With regards to current working patterns, the impact of remote working has caused the need to focus on vulnerabilities that are exposed by technologies that facilitate remote working arrangements such as the cloud and Internet of Things (IoT) devices.

As for the cloud, it has created an easy avenue for hackers to hack into a company and target employees. In fact, the cloud has created a more vulnerable environment for critical and sensitive data to be stored and given employees greater access to critical and sensitive data than ever, thus increasing the likelihood of cyberattacks and the need for employees to be trained on the threats posed by hackers.

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https://www.healthcareitnews.com/news/anz/new-zealands-national-health-plan-seeks-greater-use-digital-tools

New Zealand's national health plan seeks 'greater use' of digital tools

In the area of digital health, New Zealand aims to improve interoperability and digital access to primary care, among other planned actions.

By Adam Ang

October 31, 2022 12:22 AM

An interim national health plan in New Zealand underscores the contribution of digital tools in allowing the health system to provide more care in homes and communities.

Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – Māori Health Authority have jointly developed the interim Te Pae Tata New Zealand Health Plan 2022 which outlines a range of tasks in building a "unified, affordable and sustainable" health system.

It states that integrating digital technologies into the health service delivery system is an "essential part of the shift to a single health system." 

WHAT IT'S ABOUT

One of the six priority actions in the interim Te Pae Tata is to "develop greater use of digital services" to provide more care in homes and communities.

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https://www.healthcareitnews.com/news/onc-launches-sdoh-interoperability-pilot

ONC launches SDOH interoperability pilot

In the new peer-to-peer learning forum, participating organizations will test using FHIR standards to exchange information about social determinants of health in primary care.

By Andrea Fox

October 31, 2022 11:10 AM

This new group can use various Fast Health Interoperability Resources resources as they pilot how to best adopt the SDOH Clinical Care FHIR Implementation Guide (SDOH CC IG) in screening, diagnosis, goal setting and interventions.

WHY IT MATTERS

The pilot, funded under a cooperative agreement by the Office of the National Coordinator for Health IT (ONC) and Health Level Seven International (HL7), focuses on applying FHIR Gravity social risk terminology – to exchange information.

"Our combined efforts are expected to demonstrate how best to advance our nation’s technical infrastructure to enable SDOH interoperability as supported by ONC’s United States Core Data for Interoperability (USCDI) Version 2," ONC authors Ryan Argentieri, Samantha Meklir and Jawanna Henry wrote in ONC's HealthITbuzz blog. 

The USCDI standard consists of a core set of data classes and elements for health information exchanges to capture information about conditions outside of medical practice that put a person’s health and well-being at risk – chiefly food, housing and transportation access. 

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https://www.healthleadersmedia.com/technology/study-finds-telehealth-may-not-be-best-ed-follow-care

Study Finds Telehealth May Not Be Best for ED Follow-Up Care

Analysis  |  By Eric Wicklund  |   October 28, 2022

According to researchers at UCLA, patients using telehealth for follow-up care after ED discharge were more likely to return to the hospital and be admitted than those who followed up an ED visit with an in-person visit.


KEY TAKEAWAYS

·         A study of ED follow-up visits at two Los Angeles hospitals in 2020 and 2021 found that patients using telehealth for follow-up care were more likely than those following up in-person to return to the hospital and be re-admitted within 30 days.

·         Researchers say that's because patients receiving ED care are more likely to have acute concerns, such as chest pain, abdominal pain and shortness of breath, that need in-person treatment.

·         The study doesn't mean telehealth is a waste of time and money in the ED, as it can be used to screen and treat less-acute cases, but it does put the emphasis on understanding when and where telehealth can be used in the hospital setting.

New research finds that telehealth isn't always better than in-person care, and it can sometimes lead to more healthcare visits and even hospitalization.

A study led by researchers at UCLA and published in the Journal of the American Medical Association (JAMA) compared follow-up care for patients who'd visited the Emergency Department at the California health system between April of 2020 and September 2021, and found that patients using telehealth were more apt to seek in-person care and be rehospitalized than those who'd had in-person care.

The study analyzed almost 17,000 ED encounters from roughly 13,000 patients at two hospitals, and found that 16% of those who'd had in-person post-discharge follow-up visits returned to the ED and 4% were rehospitalized within 30 days, while 18% of those using telehealth for a follow-up visit returned to the ED and 5% were rehospitalized.

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https://www.fiercehealthcare.com/health-tech/teladoc-shares-jump-q3-revenue-membership-exceeds-expectations-amid-turbulent-years

Teladoc shares jump as Q3 losses narrow, revenue exceeds expectations amid turbulent year

By Heather Landi

Oct 27, 2022 03:19pm

After a rough ride in the first half of 2022, Teladoc had some good news to report this week as it slightly exceeded revenue expectations in the third quarter and saw robust growth in its direct-to-consumer business.

Revenue during the most recent quarter rose 17% to $611 million from $522 million a year ago, slightly surpassing analysts' expectations of $609 million.

The biggest driver of that growth was BetterHelp, Teladoc's direct-to-consumer mental health brand. BetterHelp revenue rose 35% as compared to a year ago, Teladoc's chief financial officer Mala Murthy said during the company's third-quarter earnings call.

U.S. paid memberships in the quarter rose nearly 10% to 57.8 million, above Teladoc's own expectations of between 55.5 million and 56.5 million members.

In addition to revenue growth, Teladoc also reported significant cost savings.

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https://seekingalpha.com/pr/18992729-teladoc-health-reports-third-quarter-2022-results

Teladoc Health Reports Third-Quarter 2022 Results

Oct. 26, 2022 4:05 PM ET Teladoc Health, Inc. (TDOC)

Q3: 2022-10-26 Earnings Summary

EPS of -$0.42 beats by $0.07 | Revenue of $611.40M (17.20% Y/Y) beats by $2.41M

  • Third quarter revenue grows 17% year-over-year to $611.4 million
  • Net loss totaled $73.5 million, or $0.45 per share
  • Adjusted EBITDA totaled $51.2 million
  • Cash flow from operating activities was $63.0 million for the quarter and $123.7 million year-to-date

PURCHASE, NY, Oct. 26, 2022 (GLOBE NEWSWIRE) -- Teladoc Health, Inc. (NYSE: TDOC), the global leader in whole-person virtual care, today reported financial results for the third quarter ended September 30, 2022.

“Teladoc Health delivered strong third quarter results, including robust revenue growth, and adjusted EBITDA above the high end of expectations,” said Jason Gorevic, chief executive officer of Teladoc Health (TDOC). “During the quarter we continued to make progress against our whole person care strategy as the market evolves towards integrated virtual and digital health solutions.”

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https://www.eurekalert.org/news-releases/969539

News Release 28-Oct-2022

New collaboration agreement between SNOMED International and LOINC® from Regenstrief pivotal step to enhance interoperability, health information exchange around the world

Business Announcement

Regenstrief Institute

London, United Kingdom and Indianapolis, Indiana, United States  -- LOINC® from Regenstrief and SNOMED International have signed a new collaboration agreement facilitating the adoption of standardized terminology to support broadened interoperability of health data exchange around the globe with the goal of enhancing and improving the delivery of healthcare.

The agreement also paves the way forward for coordinated use of SNOMED CT and LOINC by both SNOMED International and Regenstrief, with each retaining editorial control of its respective standard.

In addition to promoting the adoption of practices to facilitate use and interoperability of the terminology standards produced by both organizations, the new agreement targets reduction of current and potential duplication. Serving an increasingly intersecting group of global implementers, the agreement will deliver improved healthcare through standardized terminology and enhanced clinical system interoperability while providing support for providers and users who implement different combinations of both standards.

The new agreement lays the foundation for development of a LOINC extension that aligns with the SNOMED CT model, enabling SNOMED International and Regenstrief to distribute LOINC and SNOMED CT content together to their respective users. The extension will create both SNOMED CT and LOINC codes for all concepts that are shared between the terminologies, making it easy for implementers to have a unified approach to implementing both standards and to meet clinical and regulatory requirements globally.

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Enjoy!

David.

 

Friday, November 11, 2022

This Seems To Me To Be A Pretty Huge Vulnerability! I Wonder What The Contingency Plans Are?

This rather worrying, and very well researched, article appeared last week!

The internet is run under the sea, not in the cloud. What happens if the cables get hacked – or snipped?

Hundreds of undersea cables link up the worldwide web, with about a dozen connected to Australia. How does this little-known network work – and what happens if it’s sabotaged?

By Sherryn Groch and Felicity Lewis

November 5, 2022

At the bottom of the freezing Sea of Okhotsk, deep inside Russian waters, a US submarine creeps into position. Navy divers emerge from a hatch they call “the Bat Cave” and sneak along the dark ocean floor, searching for a cable just centimetres wide on which they’ve planted a listening device – and, all the while, the Soviet fleet above is none the wiser.

It’s the 1970s and this is one of the most daring missions of the Cold War: wiretapping the secret communications cable between the Soviet fleet’s Pacific base and headquarters in Russia. The Soviets thought it so well guarded, in a heavily patrolled peninsula rigged with sound detectors, that most of what passed down that cable wasn’t even in code.

For a decade, US divers would return every month to retrieve the latest transmissions captured from their bug so analysts at the US spy agency the NSA could binge-listen to the juicy disclosures – from Soviet nuclear secrets to commanders’ conversations with their mistresses. Then, after yielding some of the most useful intelligence of the Cold War, Operation Ivy Bells came to a halt suddenly in the 1980s when a bankrupt NSA analyst quit his job and walked into the Soviet embassy to sell US secrets.

A high-stakes Cold War wiretap under the sea might sound leagues away from our “wireless” world today. But the internet is not held in the “cloud” or beamed down by satellites – at least, not for the most part. More than 95 per cent of our data runs through a little-known network of undersea cables, each not much wider than a garden hose, stretching thousands of kilometres long.

While these cables are faster than satellites, some experts warn they are not well protected – and sabotage still happens. As Russia wages war in Ukraine and China expands into the private cable market, many countries are ramping up their underwater surveillance, including Australia.

How does the internet under the sea work? Can you tap a cable today? And what happens if they are snipped entirely?

What is the undersea internet network?

Right now, these words are likely travelling along the bottom of the ocean at close to the speed of light. Fibre-optic cables that transmit data as light are the superhighways on which the internet (and phone lines) travel between continents – they have much higher bandwidth than satellites and are specially reinforced to lie at the bottom of the sea, even resisting shark bites. Sci-fi writer Neal Stephenson once called them “Mother Earth’s motherboard”, and they were even entangled in the NSA surveillance scandal revealed by whistleblower Edward Snowden in 2013. A secret deal with US telco giant AT&T created the now infamous “Room 641A” at AT&T’s San Francisco site – behind its door, the NSA could tap cables coming up from the Pacific Ocean without a warrant.

More than 450 undersea internet cables crisscross the Earth, covering more than 1 million kilometres in total.

“Submarine cables have been the backbone of communications all the way back to the telegraph,” says former Australian intelligence official Dr William Stoltz at the ANU’s National Security College.

The first transatlantic cable was laid in 1858, connecting the US with Britain. Queen Victoria marked the occasion by sending a wire to US President James Buchanan – it took 17 hours to arrive. Things might be faster (and digitised) now, but the architecture is largely the same, Stoltz says.

More than 450 undersea internet cables crisscross the Earth, covering more than 1 million kilometres in total, and dozens more are planned. They can zap the equivalent of the United States’ entire collection in the Library of Congress across the other side of the world in moments. Australia is connected by at least a dozen cables itself, many of which land in Sydney and Perth.

Most of the world’s cables today still go through the US, although some nations, including those in South America and Europe, have been teaming up on routes bypassing the US, in light of the NSA spying scandal. There’s an even stronger move to bypass China and its tech giant, Huawei, long suspected of allowing backdoors for Chinese spies in its systems.

The only continent not plugged into the world’s undersea web is Antarctica, which relies entirely on satellites instead. Former Australian Antarctic station leader David Knoff likens operating without the subsea connections to “about 20 years ago, where you couldn’t watch movies, a short video clip would take an hour to download –occasionally it works but it’s a roll of the dice.” Some, including the Bureau of Meteorology, want Antarctica to get its own cable, as plans push ahead to lay lines beneath the freezing Arctic at the other end of the world.

“We don’t think about these cables, they’re out of sight at sea, but they’re vulnerable.”

Anthony Bergin, ASPI

But rolling out undersea cables is expensive and difficult. Almost all are privately owned and managed – often by consortiums of large telcos such as AT&T as well as, increasingly, the tech giants Google, Facebook (now Meta), Amazon and Microsoft. “Governments almost entirely rely on a handful of firms,” says Stoltz. “We don’t have our own sovereign capability to build, repair and inspect these things.”

Huawei Marine, now trading as HMN Technologies, has laid or repaired about 100, or almost a quarter, of the world’s cables. Google says it has invested in 22, including the newly launched 15,000 kilometre “Equiano” from Portugal to South Africa. Telstra owns a stake in 27 cables, more than 400,000 kilometres worth. “That’s the equivalent of going around the world 10 times,” says the chief of Telstra International, Oliver Camplin-Warner. “We’re the biggest provider inside Asia.”

He compares the undersea network to airline routes, following demand, “like London to Singapore”. Most people don’t realise the “magic” of how the internet works, he says. “They [often] think it just disappears up into the sky to a satellite.”

But you can wrap your hand around these cables – they are bundles of steel and copper and plastic, coated in petroleum jelly to help protect the delicate hair-thin optic fibres within. “They’re strong”, says Camplin-Warner, built today with “better armour” to withstand more extreme pressure as well as more sensors to detect disruptions.

Still, they are vulnerable – especially to natural disasters or stray boat anchors. Tonga is connected by just one subsea cable and at the start of this year, it was cut off from the world for more than a month when a volcanic eruption knocked out that line.

That’s why charting a new undersea cable route can take a year of planning. About 46,000 kilometres of new cable on average are installed globally each year – unspooled from specially fitted-out ships. “Picture almost a farmyard plough behind a tractor,” says Camplin-Warner. Near shore, “we bury the cable down into the seabed” for extra protection. Sensors on large ships set off alarms if they get too close. And Telstra uses an “Always On” system to near-instantly reroute internet traffic from one cable to another if there’s a problem. “The minute anything happens [our centres] know,” says Camplin-Warner. “We can tell how far the light [data] is travelling down the cable before it disappears so we can quickly work out exactly where the break is.”

Of course, the world’s small fleet of cable repair ships – those designed to haul up the damaged section of cable and splice in a new one – are also privately owned. “And there’s not enough,” says Anthony Bergin, a senior defence analyst at the Australian Strategic Policy Institute (ASPI). “It was weeks before a repair ship came out to Tonga and fixed their cable.”

….. Lots omitted.

How are we protecting cables? What happens if they’re cut?

The federal government did not answer questions on how it would respond to cable sabotage but said the telecommunications industry had a long history of redundancy planning. Unlike Tonga, Australia has many cables connecting it beneath the waves and Telstra, which owns 10 of them, says it could re-route data along its remaining ones if some are knocked out.

“The best-case scenario is that the internet slows down,” says former intelligence and defence official Marcus Hellyer at ASPI. But if Australia is cut off entirely, much of our digital world – from Netflix to the stockmarket – will collapse.

We’d need to switch to satellites fast – so access to the rapidly deployable kind, such as Elon Musk’s Starlink internet (now used in besieged Ukraine) or the kits Telstra sometimes sends to areas of Australia hit by fire or flooding, will be essential, Stoltz says. Even then, communications would have to be triaged (as was the case in Tonga where Telstra and the Australian government helped restore emergency communications via satellite). “You can’t go from our normal internet traffic and push it entirely on to satellite bandwidth,” Stoltz says. “They’re really only an emergency solution, short term.”

It’s why, despite advances in satellites helping connect more remote parts of the world, no one expects submarine cables to be ditched any time soon. And why developing nations need an affordable alternative to China’s “cable diplomacy”, Stoltz and Bergin say.

“For countries, particularly in South-east Asia and the Pacific, that really do rely on these big foreign telcos building this infrastructure … it’s a tension between security and economic development,” Stoltz says. “They’re the ones in the middle that we’re jostling over.”

The South China Sea is not only a tangle of disputed maritime and island claims but a “cable chokepoint” for the network.

Tong says some developing nations have a different perspective on the West’s security concerns. “I don’t think they really care if China’s reading their emails.” China is a huge economy, so cable connections to it “absolutely should” and will continue, he says. But he adds: “I think over the years people have felt a bit better about security if they are sending data transmission from Japan to Australia, for example, directly … than having it land in China first and then be transmitted.”

That’s partly why new hubs are opening up in places such as Singapore and Korea. Camplin-Warner says Australia itself is becoming an important data landing site between the US and Asia, even though “it may not be the quickest route”. One of Australia’s newest cables, Southern Cross NEXT, (which Telstra has a 25 per cent stake in) runs straight to the US, the first direct route between the continents.

Taiwan is another emerging hub, despite the tricky geopolitics, Camplin-Warner says.

And nearby, the South China Sea is not only a tangle of disputed maritime and island claims but a “cable choke point” for the network. As researcher Lane Burdette writes for Princeton University, many nations rely on cables running through those waters, but China’s build-up of artificial islands there appears to use cables that aren’t made public. And some experts fear Beijing may yet move to block or control cables and their repairs in the region.

Meanwhile, if China were to cut Taiwan’s undersea cables, sometimes described as the island’s Achilles’ heel, the impact would be felt nearby too – it’s connected by a dozen cables to countries including Australia, Singapore, Japan and the US.

In 2017, Rishi Sunak, now Britain’s prime minister, outlined a case to ramp up the defence of these “jugulars of the world economy”, including that the government install more back-up “dark cables” itself.

As another island, Australia is particularly vulnerable too, Bergin says. Yet, while the new AUKUS technology-sharing partnership with the US and the UK means greater investment in undersea capability, there’s been no focus on maritime infrastructure security.

Australia is already bringing in minimum cybersecurity standards on privately-owned critical infrastructure – including undersea internet and energy cables. And, unlike voluntary reforms in the US, it’s hoped they will have teeth. The government spokesman didn’t say how the standards will be monitored beneath the waves but said it worked closely with companies, which have “obligations to do their best to protect networks from unauthorised access and interference,” and to report breaches. The security of internet cable projects, including landing sites, is assessed when companies seek a permit to operate from their day-to-day regulator Australian Communications and Media Authority (ACMA), which also oversees repairs, the spokesman said.

At Telstra, Camplin-Warner says “security is absolutely paramount”. The telco has previously worked with Australia and other governments to bring in protected exclusion zones around landing stations, he says, and Telstra is seen as a “safe, neutral provider internationally”. “We don’t have any Huawei equipment in our network.”

Meanwhile, defence expert Malcolm Davis says Australia is investing in better tech to hunt submarines, as China tries to close the gap between its own navy and America’s. “We haven’t faced a threat like we do today in the region. The Soviets rarely sent submarines this far south.”

The federal government spokesman said a new maritime undersea combat and surveillance program was created in late 2021, with $7.4 billion for an “Integrated Undersea Surveillance program”. The Australian navy has already flagged the plans for “ocean surveillance ships”, undersea drones and sensors, and the latest October budget papers reveal $155 million in funding earmarked over the next financial year to buy an “undersea support vessel”.

Still, in the end, the best defence may be mutually assured destruction, says Hellyer. “Everyone will start cutting cables if there’s a war, but you can’t be everywhere in the ocean. We might need an agreement, [rules of law], not to touch this kind of critical infrastructure. Because once we start ...”.

The full article is here:

https://www.smh.com.au/technology/the-internet-is-run-under-the-sea-not-in-the-cloud-what-happens-if-the-cables-get-hacked-or-snipped-20221025-p5bsov.html

Around the world we are seeing all sorts of strategic tensions rising from Russia, China etc. as well as the impacts of the new European War in Ukraine.

When the cables were laid – some more that 20 years ago – I am sure no one realised just how much things would change and how quickly it would happen!

To me it is obvious we need to dramatically to increase our satellite bandwidth to the rest of the world with a range of service providers ASAP!

These threats are real and would be pretty disruptive if they came about, to say the least…

We have all been warned!

David.