Q. What are the updates for 2019 regarding Indo-Danish relationship in Healthcare?

The relationship between India and Denmark is becoming better each day. In December 2018, the Foreign Ministers of both the countries met in New Delhi and relaunched the Indo-Danish Joint Commission, which provides the framework for all strategic sectors’ cooperation including healthcare. This breakthrough paved the way for the Danish Prime Minister’s visit to India in January this year. Among other things, he participated in Vibrant Gujarat spearheading a Danish business delegation, where he also met with Prime Minister Modi. The purpose of these visits was to strengthen political and economic ties between India and Denmark because both countries will benefit tremendously from increased interaction and business collaboration. In this regard, healthcare is a key focus area for 2019. This decision is based on the success of two large projects in 2018; one is focused on non-communicable diseases and the other on attaining the SDGs within healthcare. We were able to develop concrete grounds for working in a focused manner in this field and assist Danish companies looking to gain a footing in India. Several Danish companies are already established in the Indian market including Novo Nordisk, Widex, Coloplast, Fertin, Falck and many more are expressing their interest.

Q. The Danish Health System is incorporating changes for good in recent past with new hospitals and other delivery mechanisms, can you share your viewpoint on the relevance of them to India?

The Danish health system is a publicly funded scheme, which covers all Danish citizens. There is a lot Denmark can contribute to India in terms of know-how and sharing of best practices. Areas where Denmark can assist India to include:

• Digitalization of some solutions to address the challenges that exist in the current healthcare system. Denmark is a leader when it comes to digital workflows and working with electronic health records. Like in India, there are multiple stakeholders within the healthcare system (doctors, patients, nurses, local and state authorities, pharmacies, etc.) that are bound to work together but at the same time operate as individual entities as well. Denmark managed to achieve a high level of efficiency by digitalizing processes and thus, improve efficiency.

• Digitalization has helped Denmark save both time and money. These learnings can be adopted in India to bring down costs in public as well as private set-ups.

• Empowered its patients allowing them to access all relevant information about their health and well-being. I believe that the Indian government’s launch of Ayushman Bharat Scheme is also a move in a similar direction and with the similar intent of providing better healthcare access to all. Therefore, I see a great scope of collaboration and partnership between the two countries.

• Other areas where Denmark has done exceptionally well is the use of Telemedicine for connecting patients in remote locations and reduce time at the hospitals.

• The Danish hospital system is undergoing unprecedented expansion and restructuring. Denmark has spent years of research and gathered experts from all over the world to develop 5 new national super hospitals and renovating 11 existing hospitals. India can leverage this knowledge while it is at a stage where there are still new hospitals getting on.

Q. What can India offer to Denmark, your opinion?

One of the common areas of work between Denmark and India is dealing with NCDs. It is a global challenge. Denmark is currently investing a lot in developing solutions to address this global multifaceted issue. Our research environments, universities, and companies are trying to create products that could be suitable not only for Denmark but across the globe. One of the very specific things Denmark could explore is:

• India has a lot of data available and Denmark could collaborate with India to develop solutions and therapies.

India is a bigger country with a much bigger amount of data; this can be utilized to further make the Danish healthcare sector more effective.

Furthermore, private players dominate the Indian healthcare sector, which has created different incentives and quicker implementation time. Both learnings from private players and data from India can be beneficial to the Danish healthcare sector.

Q. Any message for the readers of InnoHEALTH Magazine that you want to share?

Healthcare is a global challenge, and we need global solutions to attain the Sustainable Development Goals. Having in mind that 17 percent of the world population lives in India, it is safe to say that if India fails, the world will not succeed. Therefore, the strategic sector cooperation between Denmark and India is very important.

Evaluation–Diagnosis–Treatment. This is the traditional and generally accepted method of a medical procedure. However, the healthcare sector has evolved over the last couple of years. Today’s healthcare is using a new, digital companion to determine how patients feel based on much more than their present medical condition. Healthcare information technology or healthcare IT is widely used by doctors, surgeons, and pharmacists to understand the medical information of patients and improve communication between doctors and patients.

What is the use of Healthcare IT?

The major advantage of the healthcare IT is that it reduces the communication gap between a patient and a doctor as the healthcare IT collects and converts the patient’s information from paper records and medical charts to electronic data. This migration provides direct access to patient’s information to doctors irrespective of their location and enables to share knowledge with other doctors than the current medication providers. Moreover, the doctor-recommended prescriptions can be transmitted electronically owing to the healthcare IT, which has improved efficiency and reduced the valuable time.

Healthcare IT is much more than just an electronic version of paper medical records. It includes previous maintained medical images by radiology departments and opinions of specialists on a certain method of treatment. In addition, the digital messages including emails, healthcare tips, chat logs, the day-to-day medical progress of a patient, and financial factors such as scheduling and billing fall under the sky of healthcare IT. However, these records must be stored and maintained carefully to prevent invasion of privacy. On the other hand, technological advancements and easily accessible facilities fuel the demand for healthcare IT. Roughly, two-thirds Americans have instant access to the internet, which eliminates a patient’s restrictions with medical consultants. The tech giants such as Microsoft, Apple, and other new start-ups are developing up-to-the-minute opportunities in the healthcare IT market by improving access to digital applications and providing efficient security features. This has increased demand for healthcare IT services, boosting the growth of the healthcare information technology market. According to a report published by Allied Market Research, the market is expected to register a CAGR of 13.2 % in the period 2014–2022.

Healthcare generates job opportunities

The growth of healthcare IT has created a surge in job opportunities in the IT sector. According to the U.S. Bureau of Labor Statistics, by the end of 2024, the need for healthcare and medical managers will boost by about 17 percent. The healthcare IT management jobs oversee the entire system process and its day-to-day operations. Healthcare providers are finding hard to pick employees for job positions such as development, analytics, coding, and research. Moreover, just the collection of healthcare data is not enough. Once that data is received, it needs to be analyzed by skilled professionals and constantly updated and improved. Therefore, coding experts are extremely essential to smoothly transfer the individual records of patients to a central hub, by changing the codes that could otherwise interrupt the transfer of information. It is estimated that the requirement of such new codes is nearly 130,000. Moreover, the IT specialists assist healthcare service providers to obey the federal guidelines for records, a collection of data and share to protect a patient’s privacy. Due to such requirements, there are ample IT companies and even start-ups that are launching new platforms to develop a sustainable healthcare IT department.

Recently, Javara Inc., a clinical research service organization, launched a platform that is focused on compelling innovative research partnerships, service, and technology to healthcare systems. Jennifer Byrne, the co-founder, and CEO of Javara stated that the new healthcare IT platform will bring better outcomes for patient-centered care, better economic results, and easier research delivery model to the biopharmaceutical sector.

Integration of Artificial Intelligence in Healthcare IT

It is no secret that the healthcare sector holds a humongous amount of data; if incorporated with artificial intelligence (AI), it will open innumerable opportunities in the future. Microsoft, one of the largest information technology companies, has been working on several healthcare-related projects. Recently, Microsoft made clear its exact intentions behind developing a Microsoft healthcare team. The company aims to create a cloud-based patients’ profile, push doctors to use more cloud-based services, and eventually develop an AI to analyze the huge data. Microsoft hired two industry past masters: Jim Weinstein and Joshua Mandel to help achieve this goal. Jim Weinstein, the former CEO of Dartmouth-Hitchcock Health System, will help the migration of healthcare data to the cloud. Joshua Mandel, ex-Google employee, will assist in building open cloud architecture for all healthcare service providers.

The prime motive behind the project is to find a way to shift healthcare data to the cloud without jeopardizing its confidentiality. This new team will be a part of Microsoft’s AI research division. Peter Lee, the head of Microsoft healthcare, explained, at Microsoft, we’re confident that many aspects of the IT foundations for healthcare will move from on-premise doctors’ offices and clinics to live in the cloud. We are taking concrete steps with an initial blueprint intended to standardize the process for the complaint, privacy-preserving movement of a patient’s personal health information to the cloud and the automated tracking of its exposure to machine learning and data science. The company wants to pave the way to create an open architecture that eventually helps doctors, nurses and healthcare service providers, and to allow more time for patients to spend face-to-face with the doctors. The new platform will open new opportunities for healthcare data to be shared and to protect its privacy. Such innovative projects and huge investments in healthcare AI proves that the incorporation of AI in healthcare IT will be a fruitful investment for the healthcare providers, and no doubt it will be a key to the bright future of healthcare sector.

About the author

Nikhil Bhusare is an Executive with Allied Market Research.

Ransomware epidemic is spreading in healthcare like wildfire due to its increasing digitalization which is and will attract more attention of hackers.

The healthcare industry has been a victim of various cyber attacks in the last few years. According to recent studies, healthcare has outnumbered financial services and become the most cyber attacked industry. The latest in cyber-attack is ransomware wherein the hacker encrypts the data and threatens to publish it until the ransom is paid in form of bitcoins. In US alone, healthcare industry was the victim of 88 per cent of all ransomware attacks across industries last year.

The recent case of WannaCry ransomware crippled the IT systems of NHS, UK. And after hitting NHS, it spread globally targeting more than 99 nations. The hackers demanded payment of £300 – £600 to unlock systems and have earned about £55,000 in ransom.

Ransomware has indeed become a lucrative revenue source for hackers due to which the number of attacks is predicted to quadruple by 2020. Medical records have 10-20 times more value than the credit card data in the internet black market. Ransomware epidemic is spreading in healthcare like wildfire due to its increasing digitalization which is and will attract more attention of hackers. Also, the vulnerability of the health data tends the organizations to pay the ransom to get the data back to maintain privacy and confidentiality of patient data.

Even after so many cases of cyber attacks compromising millions of electronic health records each year, the healthcare industry is inadequately prepared to prevent and resolve these attacks. Whether it is India or US, cyber security is always discussed in forums and budget is allocated for the same but is not put to proper use. Cyber attacks happen due to outdated security infrastructure or employee negligence.

Hospitals and insurance companies have been the main targets of hackers. But, a new vulnerability is catching everyone’s attention i.e. medical devices. The next nightmare in ransomware attacks could be hacking of medical devices such as insulin pumps, pacemakers, defibrillators, implants etc.

Disfunctioning of medical devices can be catastrophic. Just imagine, hackers take control of one’s pacemaker and ask for ransom or else they would manipulate the device which could be fatal. This kind of attack has been showcased in the very famous TV show Homeland wherein the Vice President dies due to hackers remotely disable his pacemaker.

Just like the serial, the former US Vice President Dick Cheney’s doctors disabled his pacemaker’s wireless functionality due to fear of possible assassination attempts as revealed by him during an interview in 2013. This clearly showcases that medical devices can be the next target for hackers.

Regulators such as FDA are increasingly getting concerned about medical device security and have issued warning. In 2015, for the first time FDA issued safety notice to hospitals which strongly discouraged hospitals to use an infusion pump which was found to be vulnerable to cyber attacks. But it has been observed that FDA did not force the company to fix the devices being used in the hospitals and didn’t investigate other insulin pump models. This shows that FDA needs to be more stringent towards medical device security. The vulnerability of infusion pump was pointed out by a white hat hacker Billy Rios during his hospital stay.

Few of the medical device companies/providers have been proactive in strengthening their device security such as Johnson & Johnson in Oct 2016 warned 114,000 diabetic patients about a security lax that a hacker could exploit in one of its insulin pumps (J&J Animas OneTouch Ping). The hackers can disable or alter the dosage which could be fatal. J&J suggested ways to the patients for mitigating risk.

There have been no documented cases of medical device hacking till date but demonstrations have been conducted in research environment. One such example is of Barnaby Jack who succeeded in hacking an insulin pump and demonstrated giving off lethal dose of insulin without the pump alerting the user. Another example is that of St Jude Medical’s implantable devices such as pacemakers, defibrillators, and resynchronization devices. The radio frequency (RF) enabled St. Jude medical implantable cardiac device and corresponding Merlin@home Transmitter enables transmitting and receiving patient data stored on the device to the physician to monitor his health. But FDA reviewed the device and confirmed about cybersecurity vulnerabilities, if exploited, could be fatal.

Also, researchers at TrapX Security analysed three hospitals for medical device hacking. The deception technology was installed which utilized emulated medical devices in the hospitals. These emulated devices attract and trap hackers so that TrapX could trace the hackers activity. These fake medical devices such as Radiation Oncology system, LINAC , Fluoroscopy, PACS and Xray system appeared real to the hackers and TrapX could monitor hacker’s activity.

According to TrapX, these hospitals utilized older version of Windows that made it vulnerable and most medical devices did not have additional endpoint security software which made the attack undetectable. It was also noticed that the main goal of hackers was to steal medical records not to manipulate the device.

Another research at University of South Alabama showcased how they hacked pacemaker and killed a medical simulator called iStan. The $100,000 medical dummy comes equipped with robotics that mimic the human cardiovascular, respiratory, and neurological systems. The researchers could speed the heart rate up or could slow it down. Not only pacemaker, researchers could manipulate an insulin pump or a number of things that would cause life-threatening injuries or death. This clearly illustrates why medical device security is important.

With the advent of IoT, where devices are connected via internet should focus on cyber security. Industrial experts are realizing that cyber security is prime priority for all the devices connected to the internet.

Devices such as wearables, smart bed, smart emergency system, etc. are all lagging behind in cyber security. Apart from medical devices, surgical robots are not being scrutinized for cyber security. Just imagine, surgical robots been hacked which could lead to life threatening situation of the patient. One such demonstration has been showcased by researchers at University of Washington in 2015. They hacked a tele-operated surgical robot, Raven II. The experiment demonstrated three types of attacks that made telesurgery vulnerable with this robot. The researchers demonstrated how they took complete control over the robot and disrupted the operation.

All of this sounds scary but it can be prevented if we are well prepared. It is important to understand that not only regulators like FDA need not address the challenge of cyber security but also the medical device vendors and providers should take shared responsibility. It has been observed that providers point the device manufacturers to be accountable for cyber security for responding to vulnerabilities and providing fixes for the same.

On the other hand, the device vendors hold providers responsible for their negligence and having outdated network  protection. To be safe from such attacks, organisations should review their cyber defence strategies and budget. Also, employee training and awareness needs to be tackled to avoid falling for opening phishing mails and change passwords regularly.

It has also been observed that providers such as middle scale hospitals, clinics or laboratories have often overlooked cyber security as priority as they believe not much data is present with them and only the big organisations are in trouble. Which is not true, as hackers are aware of the precious financial and patient data these clinics hold and are aiming at clinics or small hospitals also to get the data. So, they should also focus on medical device security.

The next big thing in helping fight against cybersecurity is artificial intelligence (AI). According to some analysts, the advantage of using AI is it can help predict cyber attack before it happens with the use of behaviour analysis. It alerts security team on any behaviour deviation or authentication failures while accessing records. AI not only helps in detecting threats quickly but it is also cost efficient compared to the money paid by companies in ransom. It does not replace security tools but acts as an additional layer of security. AI can also help in analysing employee behaviour for avoiding any internal security breach. AI can help in bridging the shortage of skilled cyber security professionals also. According to Centre for Cyber Safety and Education, there is a shortfall of 1.8 million cyber security professionals by 2022 worldwide. Companies such as IBM are already investing in AI system Watson for cyber security.

Also start-ups such as Cognetyx are providing cognitive cyber surveillance solution to healthcare organizations. Use of AI for cyber security in other areas has been showcased, for example, the Las Vegas city officials and UK government to monitor their Public Services Network and protect their records from security threats. Whereas, the successful implementation of AI in healthcare cyber security is yet to happen.

The next wave of medical device cyber attacks can be prevented by collaborative approach and commitment from all the stakeholders. Not only the healthcare organizations should make sure their security practices and strategies are updated but the government should also help in skill development of cyber security professionals and encourage more research on medical device security by providing medical device at low cost. Since medical devices are expensive and require license, it makes it difficult for researchers to explore this area. At the end, we should not forget that we have to stay a step ahead of hackers to be a hard target for them.

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Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2 
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz 
InnoHEALTH Volume 2 Issue 1 (January to March 2017) – https://goo.gl/DEyKnw 
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6

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