3 ms·
Without any arguments it's just data. Is a lack of spending on key infrastructure, tied to poorer outcomes something we can discuss? I'm not sure this is the be
by Forge36 7y ago
Without any arguments it's just data. Is a lack of spending on key infrastructure, tied to poorer outcomes something we can discuss?
I'm not sure this is the best article to discuss the causes/mitigations.
There was one interesting data point, but no source of cause listed.
>for care centers that experienced a breach, it took an additional 2.7 minutes for suspected heart attack patients to receive an electrocardiogram.
Is this while they were prevented from performing care? Thankfully PBS's article goes into more details
https://www.pbs.org/newshour/science/ransomware-and-other-data-breaches-linked-to-uptick-in-fatal-heart-attacks https://www.pbs.org/newshour/science/ransomware-and-other-da...
>hospitals that experienced a data breach, the death rate among heart attack patients increased in the months and years afterward. This increased mortality doesn’t appear to be due to the perpetrators themselves — the hackers are not controlling the allocation of medications or doctors. Rather the issue may lie with how health care systems adjust their cybersecurity after an attack
Which makes a much different argument: the hospital response to a Cybersecurity incident increases mortality (thus: can we expect a similar uptick in negative outcomes amongst healthcare organizations who implement similar security polices?)
Research paper: https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.13203 https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.1...
The PBS article points out that security practices applied to clinicians led to this problem.
Do we have evidence that the hacking took advantage of the EMR's security issues?
>Time from door to ECG significantly increased after a breach and the elevated time to ECG persisted at 4 years after the breach. Security typically adds inconvenience by design—making it more inconvenient for the adversary. For example, stricter authentication methods, such as passwords with two‐factor authentication, are additional steps that slow down workflow in exchange for added security. Lost passwords and account lockouts are nuisances that may disrupt workflow. The persistence in the longer time to ECG suggests a permanent increase in time requirement due to stronger security measures.
So what compromise is possible to ensure fast login? Can two factor login be limited to new login devices? (Thus limiting impact to those working in new locations?)
Login devices which aren't recognized? (Ie: external servers)
Should EMR login be separated from local PC login within a hospital/emergency department? (Cold booting a PC and logging into windows would be the slowest response time).
Can we tie logins to employee badges to skip all password entry? (Lost badges would thus warrant reporting loss.)
- mjcl 7y ago> Can we tie logins to employee badges to skip all password entry? (Lost badges would thus warrant reporting loss.) You can, but typically you'd use a badge with a PIN. If you use something like this[1] with virtual desktops (VDI) that don't terminate your session when you disconnect, you can get the "time to login" down to a few seconds, since it's the same RDP session following the user around. [1] https://www.identityautomation.com/iam-platform/healthcare-clinical-workflow-solutions/qwickaccess/ https://www.identityautomation.com/iam-platform/healthcare-c...
- sandwall 7y agoMost hospital PC's allow this as an alternative, also thumbprints. We use: https://www.imprivata.com/ https://www.imprivata.com/
- JshWright 7y agoI'm not sure I buy the causal link between a small increase in door to ECG time and an increase in 30 day mortality (AFAIK, there's no other research explicitly linking those two stats). Door to reperfusion (or "door to balloon") time matters a lot, but the article doesn't mention those stats.
- Scoundreller 7y agoPossibly to get more data. Not everyone is coming in with a STEMI.
- chapium 7y agoThe solutions you propose are pretty much the norm already. PC logins are typically LDAP or AD however. ymmv whether your eme login is on the same domain as your pc login. For example, on Cerner emr they are typically separate but this has more to do with the hosting infra more than anything else. All the emr security in the world wont help you if a random piece of critical equipment that is compromised locks you out.