Recent intrusions into the hospitals’ IT systems resulted in blocked medical records including medical laboratory data
Healthcare cyberattacks continue to be a threat that bring potentially costly business consequences for clinical laboratories. Just in the past month, two hospital systems had their health information technology (HIT) systems disrupted due to security incidents. In response, the hospitals’ medical laboratories were forced to switch from digital to paper documentation and, in at least one case, the organization reportedly had difficulty accessing electronic laboratory test results.
At Tallahassee Memorial, an “IT security issue” on Feb. 2 resulted in the organization shutting down its IT systems for 13 days, including at its clinical laboratory. The hospital’s computer network went back online on Feb. 15, according to a news release.
At Atlantic General Hospital, according to an AGH news release, IT personnel discovered a ransomware attack on Jan. 29 that affected the hospital’s central computer system. As a result, the walk-in outpatient laboratory was closed until Feb. 14.
These recent cyberattacks underscore the importance for clinical laboratory leaders to have plans and procedures already in place prior to a disruption in access to critical patient data.
Healthcare cyberattacks can be a “complete blindside for a lot of organizations that think they have protections in place because they bought a product or they developed a policy,” said Ben Denkers (above), Chief Innovation Officer at CynergisTek, an Austin, Texas-based cybersecurity company, in an exclusive interview with The Dark Report. Since clinical laboratory test results make up about 80% of a patient’s medical records, disruption of a hospital’s IT network can be life threatening. (Photo copyright: The Dark Report.)
Laboratory Staff Unable to View Digital Diagnostic Results at Tallahassee Memorial
Though the exact nature of the incident at Tallahassee Memorial HealthCare has not been divulged, hospital officials did report the incident to law enforcement, which suggests a cyberattack had occurred.
Electronic laboratory test results were among the casualties of the IT difficulties at TMH. “Staff have been unable to access digital patient records and lab results because of the shutdown,” a source told CNN.
Attempts by Dark Daily to reach a medical laboratory manager for comment at TMH were unsuccessful. However, in a news release posted online shortly after the cyberattack, the health system advised staff members on dealing with the IT outages.
“Patients and families may notice the switch to paper documentation during registration, admission, or during their care, as our providers will be using paper forms, prescription pads, handwritten notes, or other similar paper methods where they may usually use an electronic process,” the news release stated. “We apologize for any delays this may create. We practice for situations like this, and we are prepared to provide safe, high-quality care to our patients during computer system downtimes.”
Atlantic General Hospital Reports Ransomware Incident to the FBI
At Atlantic General Hospital, the outpatient walk-in laboratory and outpatient imaging department both temporarily closed because of the ransomware attack.
Staff members throughout the hospital were “forced to manually check patients in and out of appointments and record all other information by hand instead of online,” Ocean City Today reported.
The hospital immediately informed the FBI of the ransomware incident and continues to work with an incident response team to determine whether criminals accessed any sensitive data. It was not clear whether the organization ultimately paid a ransom to unlock its systems.
The hospital’s medical laboratory director did not respond to an email from Dark Daily seeking further comment.
Healthcare Cyberattacks Attempt to Gain Access to Data
Therefore, it is critical that clinical laboratory and hospital staff work with their IT counterparts to verify that technology and processes are in place to protect access to patient data.
In “Labs Must Audit Their Cybersecurity Measures,” Ben Denkers, who at that time was Chief Innovation Officer at CynergisTek, a cybersecurity firm based in Austin, Texas, told The Dark Report, “Testing, validating, and auditing whether measures are working as designed is a change of mentality for a lot of organizations.” (If you don’t subscribe to The Dark Report, try our free trial.)
An IT network attack is an attempt by a cybercriminal to gain unauthorized access to devices that contain and exchange data within an organization. Although this information may be on individual devices or on servers, network attacks are often only possible after a hacker enters a system through an endpoint, such as an individual’s email inbox.
“It’s important to understand that while the network server itself might have ultimately been the target, that doesn’t necessarily mean that it was compromised first,” Denkers told The Dark Report. “Phishing is a perfect example of a way an attacker could first gain access to a workstation, and then from there move laterally to a server.”
The final cost of a healthcare cyberattack often exceeds the ransom. Media coverage can lead to an organization’s diminished reputation within the community, and if protected health information (PHI) is accessed by the criminals, a hospital or health system may need to pay for identity theft monitoring for affected patients.
As part of the settlement, Banner Health paid a $1.25 million penalty and will carry out a corrective action plan to protect PHI in the future and resolve any alleged HIPAA violations, according to the HHS Office for Civil Rights.
This hefty penalty is a reminder to pathologists and clinical laboratory managers that—when it comes to cyberattacks—the classic adage “an ounce of prevention is worth a pound of cure” is appropriate advice.
The short answer is that large volumes of COVID-19 testing will be needed for the remaining weeks of 2020 and substantial COVID-19 testing will occur throughout 2021 and even into 2022. This has major implications for all clinical laboratories in the United States as they plan budgets for 2021 and attempt to manage their supply chain in coming weeks. The additional challenge in coming months is the surge in respiratory virus testing that is typical of an average influenza season.
Stan Schofield (above center), President of NorDx, a regional laboratory corporation that supports an integrated delivery system at MaineHealth in Portland, Maine.
Rick L. Panning (above right), MBA, MLS(ASCP)CM, retired as of Oct. 2 from the position of Senior Administrative Director of Laboratory Services for HealthPartners and Park Nicollet in Minneapolis-St. Paul, Minnesota.
Each panelist was asked how his parent health system and clinical laboratory was preparing to respond to the COVID-19 pandemic through the end of 2020 and into 2021.
First to answer was Panning, whose laboratory serves the Minneapolis-Saint Paul market.
A distinguishing feature of healthcare in the Twin Cities is that it is at the forefront of operational and clinical integration. Competition among health networks is intense and consumer-focused services are essential if a hospital or physician office is to retain its patients and expand market share.
Panning first explained how the pandemic is intensifying in Minnesota. “Our state has been on a two-week path of rising COVID-19 case numbers,” he said. “That rise is mirrored by increased hospitalizations for COVID-19 and ICU bed utilization is going up dramatically. The number of hospitalized COVID-19 patients has doubled during this time and Minnesota is surrounded by states that are even in worse shape than us.”
These trends are matched by the outpatient/outreach experience. “We are also seeing more patients use virtual visits to our clinics, compared to recent months,” noted Panning. “About 35% of clinical visits are virtual because people do not want to physically go into a clinic or doctor’s office.
“Given these recent developments, we’ve had to expand our network of specimen collection sites because of social distancing requirements,” explained Panning. “Each patient collection requires more space, along with more time to clean and sterilize that space before it can be used for the next patient. Our lab and our parent health system are focused on what we call crisis standards of care.
“For all these reasons, our planning points to an ongoing demand for COVID-19 testing,” he added. “Influenza season is arriving, and the pandemic is accelerating. Given that evidence, and the guidance from state and federal officials, we expect our clinical laboratory will be providing significant numbers of COVID-19 tests for the balance of this year and probably far into 2021.”
COVID-19 Vaccine Could Increase Antibody and Rapid Molecular Testing
Arizona is seeing comparable increases in new daily COVID-19 cases. “There’s been a strong uptick that coincides with the governor’s decision to loosen restrictions that allowed bars and exercise clubs to open,” stated Dexter. “We’ve gone from a 3.8% positivity rate up to 7% as of last night. By the end of this week, we could be a 10% positivity rate.”
Looking at the balance of 2020 and into 2021, Dexter said, “Our lab is in the midst of budget planning. We are budgeting to support an increase in COVID-19 PCR testing in both November and December. Arizona state officials believe that COVID-19 cases will peak at the end of January and we’ll start seeing the downside in February of 2021.”
The possible availability of a SARS-CoV-2 vaccine is another factor in planning at Dexter’s clinical laboratory. “If such a vaccine becomes available, we think there will be a significant increase in antibody testing, probably starting in second quarter and continuing for the balance of 2021. There will also be a need for rapid COVID-19 molecular tests. Today, such tests are simply unavailable. Because of supply chain difficulties, we predict that they won’t be available in sufficient quantities until probably late 2021.”
COVID-19 Testing Supply Shortages Predicted as Demand Increases
At NorDx Laboratories in Portland, Maine, the expectation is that the COVID-19 pandemic will continue even into 2022. “Our team believes that people will be wearing masks for 18 more months and that COVID-19 testing with influenza is going to be the big demand this winter,” observed Schofield. “The demand for both COVID-19 and influenza testing will press all of us up against the wall because there are not enough reagents, plastics, and plates to handle the demand that we see building even now.
“Our hospitals are already preparing for a second surge of COVID-19 cases,” he said.
COVID-19 patients will be concentrated in only three or four hospitals. The other hospitals will handle routine work. Administration does not want to have COVID-19 patients spread out over 12 or 14 hospitals, as happened last March and April.
“Administration of the health system and our clinical laboratory think that the COVID-19 test volume and demand for these tests will be tough on our lab for another 12 months. This will be particularly true for COVID-19 molecular tests.”
As described above, the CEOs of these three major clinical laboratories believe that the demand for COVID-19 testing will continue well into 2021, and possibly also into 2022. A recording of the full session was captured by the virtual Executive War College and, as a public service to the medical laboratory and pathology profession, access to this recording will be provided to any lab professional who contacts firstname.lastname@example.org and provides their email address, name, title, and organization.
Robert L. Michel, Panelist—Publisher, Editor-in-Chief, The Dark Report and Dark Daily, Spicewood, Texas.
Given the importance of sound strategic planning for all clinical laboratories and pathology groups during their fall budget process, the virtual Executive War College is opening this session to all professionals in laboratory medicine, in vitro diagnostics, and lab informatics.
Now comes virtual waiting rooms to go along with virtual doctor’s visits. One example is Banner Health of Phoenix, Arizona. The non-profit has more than 50,000 employees in Ariz. and is the state’s largest employer. It operates 28 hospitals and multiple specialty clinics in six states, making it one of the largest health systems in the US as well.
Banner Health is working with LifeLink to deploy virtual waiting rooms in all of its 300 clinics.
What is a Virtual Waiting Room?
The Banner Health System includes 1,500 physicians who work in 300 clinics. More than one million patients in Arizona, California, Colorado, Nebraska, Nevada, and Wyoming are part of the system.
In the not too distant past, when patients visited Banner Health providers and received doctor’s orders for diagnostic tests, they then went to clinical laboratories or the lab’s patient service centers to provide a biological specimen for testing.
Now, because of COVID-19, patients at Banner Health clinics access virtual waiting rooms through a mobile device or computer. They check in virtually for video visits and may not visit a doctor’s office or medical facility at all. Instead, they engage their healthcare provider through a telehealth connection.
The introduction of the virtual waiting rooms is Banner Health’s response to the need for social distancing during the COVID-19 pandemic.
The virtual waiting rooms employ LifeLink chatbots, which interact with patients in a conversational way, and are available for both telehealth and in-person appointments. The chatbots can:
provide appointment reminders,
guide patients through completing necessary paperwork,
provide instructions on using telehealth technology,
check patients in for appointments, and
direct patients to an exam room for in-person doctor visits.
Banner Health used similar technology for patients visiting their emergency departments.
Both Patients and Healthcare Providers Need to Adapt
“The COVID-19 pandemic requires an entirely different level of thinking when it comes to providing routine patient services,” said Greg Johnsen, CEO at LifeLink, in the Banner Health press release. “Like the changes we are seeing in retail, healthcare providers need to adapt, and the waiting room experience is one area that will need to change. We take great pride in knowing that LifeLink chatbots are providing peace of mind and convenience for patients that need to see their doctors.”
A significant innovation is that patients can easily engage with the chatbots through a “one-click authentication process and then interact through a standard web browser,” rather than requiring them to download and install a mobile device app, Healthcare IT News reported.
“One of the key benefits of this chatbot technology is the ease of use,” said Banner Health’s Jeff Johnson in the press release. “Interactions that use natural language eliminate the need for user training, and there are no apps or passwords required so it’s simple for patients to interact with us securely, on any device. We have seen high engagement rates as a result.”
One thing seems certain, as COVID-19 causes increased anxiety over social distancing, it is likely that virtual healthcare, telehealth, and digital pathology will continue to be developed in the medical industry.
This has implications for clinical laboratories, because if patients are being scheduled virtually, it is just a small additional step to have the doctor see them virtually via telehealth. In such circumstances, medical laboratories will need to have a way for the patient to provide a specimen for lab testing.
Stated another way, labs and pathology groups are being squeezed by the need to operate on less revenue, while also increasing their quality of customer service to retain existing clients and expand market share. CRMs are a proven way to achieve and sustain superior levels of customer service in a surprisingly cost-effective way. In fact, many labs that implement a CRM find that the return on investment comes swiftly, in just a few months.
Clinical Laboratories and Pathology Groups Hit by Declining Prices, Revenues
“The clinical lab industry is solidly in an era where payers are slashing the prices they pay for lab tests and hospitals—struggling with their own financial problems—are cutting their lab budgets,” observed Robert L. Michel, Editor-in-Chief of The Dark Report, “These factors are motivating lab administrators and pathologists to look for solutions that allow them to run their lab at less cost, while improving staff productivity and customer service.
“This is why first-mover and early-adopter medical labs saw the potential of real-time analytical middleware and lab-specific CRM solutions to help them meet the challenge of running their labs on less money, while simultaneously sustaining superior levels of customer service,” continued Michel. “Every lab manager knows that the path to improved profitability is blocked by poor workflows, time-consuming quality metrics processes, and disconnected sales and customer service teams.”
Innovative medical laboratory managers report that their investment in laboratory-specific CRM systems (also known as healthcare-specific CRM) suddenly gives them access to data that has been locked away within their legacy LIS and other software systems. By unlocking this data in real-time dashboards and reports, they gain competitive advantage in the lab testing marketplace. A healthcare-specific CRM makes it possible to monitor a wide range of activities, including:
Proactively tracking relations with client physicians;
Monitoring workflow and lab operations in real time; and
Gaining a comprehensive view of all sales and customer service activities at both the aggregate and provider levels.
Tracking Key Benchmarks, Productivity, and Accountability
Sonora Quest Laboratories (SQL) of Tempe, Ariz., a joint venture between Banner Health and Quest Diagnostics (NASDAQ:DGX), wanted to reduce the amount of time spent collating reports and performing manual calculations, as well as breaking down cumbersome data silos across the organization in order to streamline communication and collaboration.
Prior to activating a laboratory-specific CRM platform, employees at SQL spent five hours per day pulling key metrics and reports. To move forward with strategic initiatives, the company could not continue to “struggle with endless silos of data and information,” a case study on SQL’s challenges states.
CRM Designed for Medical Laboratories and Pathology Groups
To address these concerns, SQL turned to a laboratory-specific CRM that integrates existing silos and systems into a centralized interface through automated data capturing. The solution provides detailed, real-time dashboards with visibility across the organization. Graphs and charts enable users to:
Track their progress meeting turnaround time benchmarks;
Ensure their volume is level-loaded; and
Track by the hour how many tests are coming in and completed, the case study notes.
The hc1 customer-relationship management (CRM) dashboard (above) provides an easy-to-navigate interface for tracking multiple benchmarks and key workflows for clinical laboratories and healthcare providers. (Image copyright: hc1.)
“The first step was to integrate our LIS [laboratory information system], and our timekeeping, call center metrics, and bench scheduling tools, into the hc1 CRM solution we had installed,” stated Tamara Nelson, Lean Master Black Belt at SQL. “Once that was accomplished, we could build actionable reports to determine where to focus our process improvement efforts.
“Now we can look at high-level trends in lab productivity,” noted Nelson. “We can also drill down to look at every process in our lab by hour, shift, discipline, instrument, and employee to compare time periods and other factors.”
According to the case study about Sonora Quest Laboratories, after its activation of the healthcare CRM, SQL reduced time spent pulling daily performance reports from about five hours per day to just 45 minutes a day. This increased overall employee efficiency by 85%.
SQL’s use of the CRM now makes it possible to:
Provide real-time financial and operation trend analysis to key stakeholders;
Track employee productivity across departments to drive accountability; and
Broadcast reports to immediately notify key stakeholders of any risks, missed benchmarks, or red flags.
Better Way for Clinical Laboratories to Track Client Interactions
Another medical laboratory that benefitted from implementing a laboratory-specific CRM is Incyte Diagnostics of Spokane Valley, Washington. Founded in 1957 by pathologists, Incyte provides anatomic pathology services throughout the Pacific Northwest.
Incyte needed a way to consolidate data coming from the multiple systems used to manage its sales process and payer information. The different systems created a disconnect between departments and, as structured, could only deliver a few real-time insights into volume or revenue shifts, client account activity, marketing campaigns, or sales activities.
Having received 35,000 e-mails from his sales team during the previous two years, Incyte’s Chief Marketing Officer Nate Koenig knew he had to find a better way to track client interactions.
“We needed a better understanding of what was taking place within our clients’ hospitals. To grow, we had to improve. That’s where the CRM solution we selected proved invaluable,” stated Koenig in a case study detailing how Incyte found a solution to tedious workflows and disorganized information tracking.
After adopting a healthcare CRM, Incyte could:
Help sales reps gain more field time;
Centralize client information;
Track sales activities;
Properly store data; and
Gain access to real-time analytics.
Anatomic Pathology Lab Exceeded Production Goals and Customer Expectations
According to the case study, by eliminating data silos and streamlining sales operations Incyte was able to:
Exceed its sales growth goal in 2016 by 107%;
Retain 99.51% of current business;
Reduce the overall workload of the client services team 6.25%; and
Gain 32 additional days of field time for its 17 sales reps.
Both Sonora Quest Laboratories and Incyte, Inc., are examples of how innovative medical laboratories are using informatics to meet the challenges of declining revenue and the need to sustain a high level of customer service. In today’s connected world, those labs that are first to achieve useful integration of their LIS with a CRM will enjoy competitive advantage.
This essential resource demonstrates how a laboratory-specific CRM enables medical laboratories to not just survive, but to thrive in today’s healthcare environment, while providing added value to healthcare consumers and providers.
Nation’s largest gathering of clinical laboratory Lean, Six Sigma, and process improvement practitioners took place in New Orleans this week
DATELINE: NEW ORLEANS, LOUISIANA—More than 300 of the nation’s leading quality improvement practitioners in clinical laboratory operations came together this week to share, learn, and master the best approaches to improving the quality of medical laboratory operations in ways that improve performance and productivity even while delivering substantial reductions in cost.
The opening session of the Ninth Annual Laboratory Quality Confab featured three clinical laboratories that have aggressively used quality management methods, including Lean and Six Sigma. These are labs that are strategically committed to creating and sustaining a culture of quality and continuous process improvement. (more…)