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Western Reserve CIO Pamela Banchy on Tackling Security Challenges through IT and Clinician Collaboration

February 5, 2018
by Heather Landi
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Healthcare organizations are facing a persistent, accelerating barrage of cybersecurity threats that pose risks to data security and patient privacy. Increasingly, healthcare CISOs and IT leaders are recognizing that when it comes to securing patient data, it takes a village—every team member at the organization needs to advance upon the organizational cybersecurity framework.

Pamela Banchy, R.N., is the CIO and vice president of clinical informatics and transformation at Western Reserve Hospital and Health System, a physician-hospital organization based in Cuyahoga Falls, Ohio, with Western Reserve Hospital serving as one of Northeast Ohio’s most advanced community hospitals. Banchy is slated to be a speaker at Healthcare Informatics’ Cleveland Health IT Summit at the Hilton Cleveland Downtown on March 27 to 28, where she will participate in a panel discussion on clinician and IT collaboration on cybersecurity and privacy practices. Banchy will share her perspectives on cybersecurity challenges and how clinicians and security personnel can collaborate to craft effective incident response protocols, among other topics.

Banchy is an experienced health IT and nursing informatics leader and has been in healthcare for more than 30 years. Before becoming CIO of Western Reserve, she was the system director of clinical information systems for Summa Health System in Akron, Ohio. Healthcare Informatics Associate Editor Heather Landi recently caught up with Banchy to discuss cybersecurity challenges as well as what her top priorities are right now and what her nursing informatics background brings to the CIO role.

There is often tension between security personnel and clinicians regarding clinical workflows and security elements. Is that changing, and are you working to address that at your organization?

It’s evolving, and it’s evolving through public recognition that that this is something that needs to be paid attention to and that there needs to be education and training. I think that the government has done a good job of leading organizations to awareness. Obviously, with Meaningful Use, and with the security aspect of walking through what that means from a regulatory requirement perspective, that was a first step. That was several years ago, and now it’s at a different level whereas, across the U.S., there have been some known risks and exposures, and with the expectation and confidence that those who are in IT value and respect that, and do everything they can to protect that information. From a tension perspective, security is an inconvenience and it is viewed that way by many, but it’s also seen as a necessary aspect of risk-adverse behaviors, with the recognition that there are people out there who want to cause harm. It is seen as an inconvenience; it’s extra steps, it’s extra clicks. The biggest area where we see that is communication, peer to peer, and secure texting. That, right now, is uppermost in many organizations, and CMS [The Centers for Medicare & Medicaid Services] just came out with a statement about texting and PHI, and the rules around that. I think a lot of that is difficult; it’s creating some challenges with respect to enforcement. And so, if I see any tension, it’s around the enforcing of the best practices from a security and safety perspective. [Editor’s note: In January, CMS released a memo clarifying its policies on whether healthcare providers can use text messages to communicate patient orders. CMS stated that texting patient information among members of the healthcare team is permissible if accomplished through a secure platform, but texting of patient orders is prohibited regardless of the platform utilized. CMS stated that providers should use Computerized Provider Order Entry (CPOE) to submit patient orders.]

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What are your top priorities right now at Western Reserve?

Our biggest one is obviously security. We have a major undertaking, both with our internal and external security program. Another priority is to look at ways that we can continue to be efficient in providing our clinicians with the right information at the right time with the right method, and how do we do that, whether it’s through HIEs [health information exchanges] or dynamic tools. So, that’s a huge undertaking for us.

You are a CIO with a nursing and nursing informatics background. What does your nursing background bring to the CIO role?

I would consider it unusual [for a CIO to have a nursing background] and I’ve been in healthcare for over 35 years, as a nurse. I’ve been in IT for 25 of those years. I think it’s allowed me to understand the needs of the patient, and organizationally, our mission and vision of a patient-first, patient-centric focus. I understand what that means and I am able to translate that. I’m also what I would consider a transformational leader; I transform for those that are more technical in their skills, training and job functions as to what that means to the patient and the clinician. And that, I believe, lends itself to not only credibility to the organization, but also credibility to the IT and IS department.

What are some current initiatives that you are focusing on in that clinical transformation role?

From that technology perspective, we have wireless infrastructure that is built on older technology, an older architecture, and its functionality has become obsolete. So, when physicians say, ‘I’m having challenges with delivering care, because the workstation on wheels keeps dropping,’ that’s a problem. In looking at the why, and how to resolve that, I can then take that example and go to my infrastructure team and say, ‘Do you understand what that means? In this particular example, we have to make sure that we have the infrastructure to support the patient care needs.’ I always tell the story of ‘Tell them the why.’ So, I go to my infrastructure team and say, ‘If your or one of your family members was in that patient’s bed and your physician comes into the room with a mobile cart, and they try to look up your chest X-ray and the computer didn’t work, would that be acceptable to you?’ That’s the why. We need to focus on maintaining and optimizing and keeping our technology that’s invisible to most, keeping that up-to-date and current as possible. So that’s a transformation, in my opinion.

Health systems are increasingly focused on population health and the data and analytics to support that. What has been Western Reserve’s journey so far into population health management, and what is IT’s role in that?

We are very involved in our population health and analytics platform. We work very collaboratively with our medical staff leadership, our clinical leadership, and our quality management department to understand what the guidelines are and monitor those on a regular basis, so regular monitoring and providing the tools and the timely reporting, both data extraction and feedback, to our clinicians to understand where we have opportunities. We have one or two vendors that we use heavily. For example, IT initiated the relationship with the vendor and they came on site and helped our organization look at our quality metrics of population health and to show us, with real-time data, where we are performing well, and also where we have opportunities. So, that’s a big collaborative effort between IT and clinicians, and we are outcomes-focused and so we’re looking at those quality metrics, in collaboration with not only IT on-site but also vendors. So, we facilitate that triad—clinicians, IT and vendors.

How are you leveraging data and analytics in Western Reserve’s value-based care and payment initiatives?

We use real-time data to look at where are cost occurrences are and to understand how we can have an impact on that. We have a value analysis committee that looks at our spend with a lot of focus on our surgical areas because of things like joint replacements, and the medical supply equipment issues, in the operative services area. There is a committee that meets to review the spend and evaluate products for the most high-quality, low cost supplies. And that’s a multi-disciplinary group; supply chain, finance, medical staff and clinical nursing all participate in that.

 

 


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Healthcare’s “RegTech” Opportunity: Avoiding a 2008-Style Crisis

September 21, 2018
by Robert Lord, Industry Voice, Co-Founder and President of Protenus
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In the financial crisis of 2007 to 2009, the financial industry suffered a crisis of trust. A decade later, banks and other financial institutions are still working to regain the confidence of consumers and regulators alike. In 2008 and 2009, while working at one of the world’s top hedge funds, I had a front-row seat to the damage that occurred to our economy, watching as storied corporate institutions fell or were gravely damaged. Today, as co-founder of a health technology company, I see healthcare is approaching a similarly dangerous situation. We must get ahead of the curve to avoid disaster.

Like finance, healthcare is a highly-regulated industry where non-compliance can result in severe financial and reputational consequences for healthcare companies, and severe impact on people’s lives. We deal with HIPAA, MACRA, HITECH, and hundreds of other foreboding acronyms on a daily basis. A lot of attention goes to the terrific and important work of clinical decision support, wellness apps, and other patient care technologies, but problems in the back office of hospitals must be addressed as well. One of these problems is the amount and complexity of healthcare regulation, and our healthcare system’s inability to keep up.

In finance, where I spent the early part of my career, the adoption of what is termed “RegTech” (regulatory technology) was driven by the increasing complexity of financial technology and infrastructure sophistication.  As trades moved faster, and as algorithms, processes and organizations became more complex, the technologies needed to ensure regulatory compliance had to move in tandem.  The crisis we experienced in 2008 was partially the result of the inability of the industry’s regulatory capabilities to keep up with the pace of technological change.  In many ways, the industry is still playing a catch-up game.

As healthcare professionals, looking to the lessons learned by our colleagues in finance can help us predict patterns and stay ahead of the curve. Right now, I’m seeing alarming parallels to challenges faced in finance a decade ago.

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Robert Lord

The burden of regulation across our industry is simply staggering.  Thirty-nine billion dollars of regulatory burden is associated with healthcare annually, which is about $1,200 per patient, per year. Despite this high cost, we still have $1 trillion of fraud, waste and abuse in our healthcare system. With so much regulation, why are we seeing so little yield from that burden? In many cases, it’s because we’re merely checking boxes and not addressing core risks؅. Like finance, there was a great deal of effort on compliance with regulations, but not enough attention on addressing important systemic risks.

This is not to say I am against good regulation; in fact, many regulations serve to protect patients and improve care. The problem is that there are so many demands on healthcare systems, that compliance and regulation is often reduced to checking boxes to ensure that minimum defensible processes are built, and occasionally spot-checking that things look reasonable. We currently have nowhere near 100 percent review of activities and transactions that are occurring in our health systems every day, though our patients deserve nothing less. However, unless overburdened and under-resourced healthcare providers and compliance professionals can achieve leverage and true risk reduction, we’ll never be able to sustainably bend our compliance cost curve.

Systemic problems are often not discovered until something goes horribly wrong (e.g., Wall Street every decade or so, the Anthem data breach, etc.). Today In the financial industry, RegTech provides continual, dynamic views of compliance or non-compliance and allows management, compliance professionals and regulators to check compliance in real-time. They can view every record, understand every detail, and automate investigations and processes that would otherwise go undetected or involve lengthy and labor-intensive reviews.

The real promise of these new capabilities is to allow compliance professionals and regulators to perform the truest form of their jobs, which is to keep patient data secure, ensuring the best treatment for patients, and creating sustainable financial models for healthcare delivery. RegTech will open up lines of communication and help create conversations that could never have been had before—conversations about what’s not just feasible for a person to do, but what’s right to do for the people whom regulation seeks to protect.

No longer bound by limited resources that lead to “box-checking,” compliance officers can use new and powerful tools to ensure that the data entrusted to them is protected. At the same time, healthcare management executives can be confident that the enterprises they manage will be well served by risk reducing technological innovation.  Patients, the ultimate beneficiaries of healthcare RegTech, deserve as much.

Robert Lord is the co-founder and president of Protenus, a compliance analytics platform that detects anomalous behavior in health systems.  He also serves as a Cybersecurity Policy Fellow at New America.

 


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HIPAA Settlements: Three Boston Hospitals Pay $1M in Fines for “Boston Trauma” Filming

September 20, 2018
by Heather Landi, Associate Editor
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Three Boston hospitals that allowed film crews to film an ABC documentary on premises have settled with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) over potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

According to OCR, the three hospitals—Boston Medical Center (BMC), Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH)—compromised the privacy of patients’ protected health information (PHI) by inviting film crews on premises to film "Save My Life: Boston Trauma," an ABC television network documentary series, without first obtaining authorization from patients.

OCR reached separate settlements with the three hospitals, and, collectively, the three entities paid OCR $999,000 to settle potential HIPAA violations due to the unauthorized disclosure of patients’ PHI.

“Patients in hospitals expect to encounter doctors and nurses when getting treatment, not film crews recording them at their most private and vulnerable moments,” Roger Severino, OCR director, said in a statement. “Hospitals must get authorization from patients before allowing strangers to have access to patients and their medical information.”

Of the total fines, BMC paid OCR $100,000, BWH paid $384,000, and MGH paid $515,000. Each entity will provide workforce training as part of a corrective action plan that will include OCR’s guidance on disclosures to film and media, according to OCR. Boston Medical Center's resolution agreement can be accessed here; Brigham and Women’s Hospital's resolution agreement can be found here; and Massachusetts General Hospital's agreement can be found here.

This is actually the second time a hospital has been fined by OCR as the result of allowing a film crew on premise to film a TV series, with the first HIPAA fine also involving the filming of an ABC medical documentary television series. As reported by Healthcare Informatics, In April 2016, New York Presbyterian Hospital (NYP) agreed to pay $2.2 million to settle potential HIPAA violations in association with the filming of “NY Med.”

According to OCR announcement about the settlement with NYP, the hospital, based in Manhattan, violated HIPAA rules for the “egregious disclosure of two patients’ PHI to film crews and staff during the filming of 'NY Med,' an ABC television series.” OCR also stated the NYP did not first obtain authorization from the patients. “In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop.”

The OCR director at the time, Jocelyn Samuels, said in a statement, “This case sends an important message that OCR will not permit covered entities to compromise their patients’ privacy by allowing news or television crews to film the patients without their authorization. We take seriously all complaints filed by individuals, and will seek the necessary remedies to ensure that patients’ privacy is fully protected.” 

OCR’s guidance on disclosures to film and media can be found here.

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Independence Blue Cross Notifies 17K Patients of Breach

September 19, 2018
by Rajiv Leventhal, Managing Editor
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The Philadelphia-based health insurer Independence Blue Cross is notifying about 17,000 of its members that some of their protected health information (PHI) has been exposed online and has potentially been accessed by unauthorized individuals.

According to an article in HIPAA Journal, Independence Blue Cross said that its privacy office was informed about the exposed information on July 19 and then immediately launched an investigation.

The insurer said that an employee had uploaded a file containing plan members’ protected health information to a public-facing website on April 23. The file remained accessible until July 20 when it was removed from the website.

According to the report, the information contained in the file was limited, and no financial information or Social Security numbers were exposed. Affected plan members only had their name, diagnosis codes, provider information, date of birth, and information used for processing claims exposed, HIPAA Journal reported.

The investigators were not able to determine whether any unauthorized individuals accessed the file during the time it was on the website, and no reports have been received to date to suggest any protected health information has been misused.

A statement from the health insurer noted that the breach affects certain Independence Blue Cross members and members of its subsidiaries AmeriHealth HMO and AmeriHealth Insurance Co. of New Jersey. Fewer than 1 percent of total plan members were affected by the breach.

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