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Exclusive Interview with India's National Cybersecurity Coordinator

InnoHEALTH Magazine — Mon, 14 Oct 2019 05:23:08 +0000

Vision for cybersecurity: An exclusive interview with India’s National Cybersecurity Coordinator at Prime Minister’s Office

-Interviewed by Sachin Gaur, executive editor, InnoHEALTH Magazine

Lt General (Dr.) Rajesh Pant is an internationally recognized Cyber Security expert, presently tenanting the prestigious appointment of National Cyber Security Coordinator at the Prime Minister’s Office, India. General Pant brings to the table an interesting mix of military operations, academic excellence, corporate governance, and cybersecurity wisdom. Prior to this, he was the Head of the Army’s Cyber Training establishment for three years. He served in the Army Signals Corps for 41 years wherein he was awarded three times by the President of India for distinguished service of the highest order. He also served as the Chairman of Precision Electronics Ltd as a Governing Council Member of IETE (India). Sachin Gaur interviewed him on his viewpoint on India’s vision for cybersecurity.

Q. On behalf of InnoHEALTH Magazine, we congratulate you on your new assignment. For our readers, we would like you to share your short-term and long-term vision for Cybersecurity from national security perspective.
Short-term vision is to issue National Cyber Security Strategy 2020-25 early next year. Task force is working overtime on this by consulting all stakeholders. Long-term vision is to create an all-encompassing cyber vertical at the national level, to handle incident response, cybercrimes, legal issues and capacity building.

Q. We know that there are some fundamental technological shifts waiting to happen like 5G, and along-with it massive (Internet of Things) IoT deployments and especially use cases of connected healthcare. Can you share your views on the cybersecurity implications of the connected devices?
IoT security is a priority topic world over and this is because the limited security capabilities of these devices are also an afterthought. We need to work on a framework, to bring baselinesecurity through the manufacturers and developers of these devices. These devices are omnipresent in our lives, we find them in our home environment to industrial environments including hospitals. We have seen attacks in the past, where such devices are compromised to launch massive denial of service attacks to manipulate the workings of critical infrastructure.
Also, the issue of IoT security is multidimensional, from data security, privacy to device security. As we discuss this, there are multiple acts and bills pending in the Parliament on these topics. While the bills and acts will provide a framework, we need to also create awareness on both sides, supplier and consumer on the possible risks and mitigation strategies.

Q. What steps can be taken to improve the security in such connected devices?
When I say baseline security framework, it can be achieved in multiple ways.
As of today, most devices that we use including mobile phones, do not have a security testing certification. So, we can agree with the industry and look at important test cases and if they can do self-certification on such test cases.
For example: the device should not have weak default login credentials, it is sending data to a remote server and can be operated remotely. So, we can come up like a 5-star rating framework like that of the energy consumption but for the security of IoT devices basis what kind of tests they clear.
Industry bodies can agree on various levels of security and what it takes to achieve that level. Such a framework, when implemented, can provide confidence to consumers and users on the kind of device they are using vis-a-visthe use case they have at hand. So, they might use a higher security rating device in a use case where the stakes are high.
The other approach is to get the security testing done with notified agencies. Department of Telecom for example has announced mandatory security testing of network elements for telecom given telecom is a part of the critical infrastructure and security issuescannot be taken lightly.
Also, some of the emerging concepts in connected devices are missing in the various governing acts of the industrial connected devices. So, we also need to update our legal frameworks to cover software-based tempering of such devices and make the manufacturers and service providers accountable and proactive towards the security of the systems they provide.

Q. What are the threats that you foresee for the health sector?
There are three areas we see where health sector can be impacted:
First is the data breaches and ransomware attacks on healthcare data. As we know, among all the data, healthcare is the most sensitive and sought after by malicious actors. Outside of India, we have seen umpteen cases where ransomware has crippled the health system and it is only after paying the ransom the hospitals can start operation again. Timely backups and encryption of healthcare data during storage is a preventive measure that clinical establishments can take to mitigate the breach and ransomware attacks.
Second is the manipulation of connected devices. The topic of IoT and connected devices security, as discussed in the above sections, directly apply to the medical devices. Healthcare is a domain where attacks on such devices can be life threatening, especially when there are implantable devices. As we have the new Medical Device Regulation Act in India since 2018, we should also consider cyber security aspect in the devices which have a communication interface. For example, a pacemaker which has a communication interface can be manipulated remotely and the patient’s life is at risk.
Third is the manipulation of health system including the building management. We are probably not very far from the days when sophisticated attacks, as we see in the movies, on high security establishments by manipulating the building controls. The building management systems are very weak when it comes to security. Every hospital is a building and imagine what a false fire alarm would mean to patients in Intensive Care Unit. Or even loss of air conditioning or sudden spikes in electrical power.
There is a proposed act DISHA, Digital Information Security Healthcare Act, which might address some of the legal aspects of security in the healthcare setting. A lot needs to be done in this area, and we are on our way.

Q. Our readership consists of health experts all over the world. Any message for them?
We are at the cusp of a new age where we look to take advantage of Artificial Intelligence to Internet of Things. For such a knowledge economy to take off, health sector is at the center of it and health experts need to pay attention on what they are buying and how such systems are managed and operated. Through intervention of Ministry of Health & Family Welfare and responsible bodies such as National Accreditation Board of Hospitals & Healthcare Providers (NABH) of Quality Council of India, we plan to recommend a cyber audit and increased awareness of information security.
We would not want our hospitals and clinical establishments to be a prey for malicious actors. Rather we would want our experts to leverage technology to take the country to the next level in providing care to a wider population at a lower cost and of the highest quality.

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Economic Times Hospital Strategic Management Summit

InnoHEALTH Magazine — Tue, 23 Apr 2019 09:19:07 +0000

The Economic Times Hospital Strategic Management Summit delivering innovative and world-class hospital planning
Mumbai – India’s Healthcare sector stands at a crucial inflection point and poised for take-off. A burgeoning population, a booming economy, rapid urbanization and a growing awareness and appetite for pursuing healthcare; these are the ingredients going into the formula that has spurred the growth of the Healthcare industry. However, every rose has its thorn. Indian healthcare expenditure is still amongst the lowest globally and a significant challenge exists in terms of accessibility of healthcare service and quality of patient care, what with a majority of healthcare focused in India’s urban areas.

In an effort to give a fillip to the ecosystem, the second edition of The Economic Times Hospital Strategic Management Summit 2019 held at The Hyatt Regency brought together government officials, healthcare industry leaders, analysts & service providers under one roof to focus on delivering innovative and world-class hospital planning. While healthcare systems and hospitals are faced with increasing pressure to find operating efficiencies in a time where traditional cost-cutting methodologies are producing diminishing returns, it is imperative to create a sustainable healthcare funding mechanism.

The conference convened with a noteworthy Keynote Address on Patient-centric healthcare system and profitability by Rajit Mehta, CEO and MD, Max Healthcare, who stated that, “To give the best care to a patient, a hospital’s DNA needs to be right, and all the DNA needs to come together i.e. doctors, nurses, and administration. Unless you don’t get your DNA right, you can’t give the best to the patient”.

In a panel discussion focusing on Ensuring Profitability Through Optimum Patient Care, Dr. K. Ravindranath, Founder & Chairman, Global Hospitals opined that “Our doctors, staff and everybody needs to be educated in such a way that they become involved partners in patient care. From the beginning, our organization has always focused on delivering patient-centric doctor driven care”.

Dr. Tarang Gianchandani, CEO, Sir HN Reliance Foundation Hospital added, “Clinical outcomes are the key and it’s the future, so not only will it improve patient satisfaction, but it will also help the hospital to ensure that costs are taken care of. We always say; what we don’t measure, you can’t improve. In the same way, if you don’t measure your clinical outcomes how will you improve, and if you don’t improve your clinical outcomes, what satisfaction will you give to the patient?”.

Dr. B.K Rao, Chairman, National Accreditation Board for Hospitals and Healthcare Providers (NABH) made a succinct point when he explained, “Accreditation is a holistic kind of thing, it’s a process, it’s not an event and if you really look at what we are talking about, we are talking of quality and safety of the patient and we agree whatever you may do in the hospital or in the healthcare industry, quality and safety is an integral part of every activity”.

Addressing the topic of Futuristic Models in Home Health Care, Meena Ganesh, Co-Founder, MD & CEO, Portea Medical proclaimed, “The movement towards setting up of quality standards is a very important move that’s happening in the whole hospital care space”.
Ram Natesan, Group COO, SRM Institute of Medical Health Sciences & Research also aired his views, stating that, “Blockchain is going to impact the healthcare sector in a very big way, starting from patient data management, patient medical records, the insurance claim process management and publishing of research papers. Blockchain is going to impact healthcare in every stream of clinical excellence, because this is one technology which can not be erased or duplicated, and this will help long way for maintaining the patient data medical records”.

About Times Strategic Solutions Limited
Times Strategic Solutions Ltd., functional under the brand name ET Edge, is an Economic Times initiative founded to empower multiple industries and segments by sharing critical business knowledge through strategic conferences and summits. Encompassing the Indian business vista, ET Edge strives to bring together visionaries and key leaders on its knowledge platforms to create social and business ecology conducive to the positive changes required by the industry. The main aim of this initiative is to channel global business intelligence through summits and conferences in overarching lectures, hands-on workshops, panels, roundtables, and case studies.

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Non-Pharmacological Management of COPD

InnoHEALTH Magazine — Wed, 17 Apr 2019 08:46:29 +0000

Chronic Obstructive Pulmonary disease (COPD) is a chronic inflammatory condition of the lungs causing obstructed airflow from the lungs (previously known as Chronic Bronchitis and Emphysema). Most common symptoms are chronic cough, sputum production, and breathing difficulty. Risk factors for COPD are smoking, indoor air pollution (biomass fuel used for cooking and heating), outdoor air pollution and occupational dust and chemicals (vapors, irritants, and fumes).

COPD is the fifth leading cause of death as per World Health Organisation 2002 report and likely to be the third leading cause by 2030. It is not only deaths, but the financial burden on individuals and the countries is huge. Regular follow-up with the doctor and taking medication regularly is one part.

Non-pharmacological interventions (Pulmonary rehabilitation) which are useful in the management are:

Smoking cessation- most important, it helps in a further decline of lung function and symptom improvement

Diet- those with high BMI (body mass index) increased work of breathing – should lose weight. Those with low BMI-with reduced muscle mass will have a weakness: nutritional supplementation advised

Exercise- increasing muscle strength, breathing techniques – such as Pranayama are proven to be helpful

Occupational safety- strategies aimed at reducing the burden of inhaled particles and gases

Vaccination- flu vaccination and pneumococcal vaccines help in reducing exacerbation of COPD

About Aware Gleneagles Global Hospitals

Our 300 bedded L. B. Nagar Hospital consists of seven-operation theatres with advanced quaternary care facility with state-of-the-art infrastructure certified by NABH, NABL & HALAL. The hospital caters to several key specialties including oncology, neurosurgery, and liver diseases besides various ailments. It brings advanced technologies that drive new and more effective treatments. Aware Gleneagles Global Hospitals cater to several overseas patients suffering from various disorders such as liver ailments, kidney failures, breast cancer, leukemia, neurological disorders amongst others. We have an international reputation as a center of excellence for advanced clinical care.

Aware Gleneagles Global Hospitals is part of Parkway Pantai, a fully owned subsidiary of IHH Healthcare. In India, we operate as a chain of multi-super specialty hospitals offering tertiary and quaternary healthcare services with over 2,000 beds and state-of-the-art, world-class hospitals in Bangalore, Chennai, Hyderabad, and Mumbai.

We aim to strengthen and expand our leading market position as a destination for multi-organ transplant for patients from India, Africa, the Middle East, and South East Asia. We are committed to further our aspiration of making quality healthcare more accessible to all. Website: www.gleneaglesglobalhospitals.com

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Real time patient monitoring system

InnoHEALTH Magazine — Thu, 08 Feb 2018 08:24:33 +0000

Real time patient monitoring system at a destination healthcare facility

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Dr. Chandy Abraham has extensive experience of working in both clinical as well as academic settings in India and the United Kingdom and is currently Chief Executive Officer, Medical Director. Dr. Chandy is a “lead surveyor” for the “National Accreditation Board for Hospitals and Healthcare organisations,” the Indian accreditation agency which works for ensuring quality in the healthcare sector.

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Dr. Vinit Raj, Quality Officer, A Certified Healthcare Quality Professional with a Masters in Hospital Administration and over 9 years of experience in healthcare quality. He has successfully completed 8 Joint Commission International surveys for the hospitals in India, Middle East and North America. He has completed a Certificate Program on Patient Safety and Quality from National Association for Health Care Quality & Harvard Medical School USA.

The era of technology and digitization has been a catalyst for all the improvements in the healthcare industry. It has bridged the communication gap between healthcare providers and patients and it has been the driving force for better and more accessible treatment, improved patient care and efficiency.

Patient satisfaction is of paramount importance. And this article speaks about our journey of improving the patient feedback system and response rates in order to address the needs of the patient in real time.

Digital survey tools are nothing special in the business world, but they are the new tool in the healthcare system still burdened with paper. Traditional paper-based surveys— usually used by a subset of patients often yield feedback from less than 10 percent of the patient population, can be subject to transcriber error and typically do not provide timely or statistically reliable data.

Background:

Patient experience has become an increasingly important component in the assessment of healthcare systems worldwide. The measurement of patient experience is important because it provides an opportunity to establish benchmarks and to monitor the performance of health care organizations, to improve care, to enhance strategic decision making, to pay attention to patients’ expectations and to make healthcare organizations more transparent and accountable to their local populations.

With the evolution of digital applications, such as app-based surveys and touchscreen kiosks we choose to move away from the paper based surveys to a digital methodology to measure patient experiences real time and act on it quickly.

Paper Patient Survey forms

Six months ago,we were worried as we were not getting the desired response rates of patient surveys and we were spending lot of time in analyzing the results and the time consuming step of segmenting and sending the results to the concerned department. It was difficult and time consuming to keep a track of the complaints and also patients were not very keen to fill a paper feedback form. Of course, one of major drawbacks in a fledgling but growing organization is that the data was retrospective and helped with system changes but did nothing for the patients while a commitment to excellence in the hospital, our top management and the board decided to digitize this process as a way to manage the patient complaints efficiently.

From the end of last year, Health City Cayman Islands started managing the Patient satisfaction surveys and feedback digitally with the help of an App to capture real time patient experience and to act on patient concerns quickly.

Touchscreen kiosks were placed in strategic locations of the hospital with a message for the patients to use problem occurred.

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Time consuming to analyze the results

Being a new organization and also working on the principles of lean management, our customer care manager does multitasking and collecting the surveys every week, analyzing it and sending it to respective departments did consume a good chunk of time.

Moving to Digital Patient satisfaction Surveys

As patient satisfaction is one of the key components of our all-round the feedback system and also surveys were given to Inpatients at the time of discharge using tablet computers.

Emailing Survey links to the patients:

To capture the unbiased feedback we also started sending the survey link to all the patients via emails and the links were directly merged with the kiosk survey responses.

This system help edour team to analyze patient feedback instantly and accurately, eliminating the use of paper and long wait times for results to be analyzed. Furthermore, it has encouraged more participation from patients.

Real time feedback

The digital system has helped us to see the responses in real time on the dashboards of the heads of departments which helps them act on the concerns in quick time.

Better Patient experience

Majority of the patients are tech savvy these days and they feel comfortable to use the kiosk compared to the paper forms.

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Quick action on complaints

All heads of the departments have access to the feedback dashboards on their computers and they can see the complaints real time which has helped with action on complaints quickly.

The assigned tasks and the status of the action taken is also available on the dashboards.

The Quality manager assigns the task to the concerned departments for all low rating feedback.

Studies in several countries suggest that healthcare managers and clinicians often struggle to link patient experience data to local improvement initiatives. Robert et al. found that appointing a champion or leader on patient experience resulted in a significant improvement in the quality of patient experience research and in the ability of organizations to act on the results.

Track the progress

The dashboard has a section to see all the assigned tasks and the status of the task. The concerned department has to complete the task by taking corrective actions like speaking to the patients and taking necessary actions.

Email alerts for low ratings

We get emails for all the low rating feedback and also daily, weekly and monthly summary of the responses.

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Reduced time in analyzing the results

The system automatically analyze the results and it takes two less than minutes to get the detailed summary of the results.

Net Promotors Scores

The system automatically calculates the net promotors scores which is consider more relevant in assessing the patient’s satisfaction level.

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Conclusion:

Many hospitals have adopted digitized patient feedback systems and continually gauging patient satisfaction and using the digital feedback system to build on quality improvement initiatives will help demonstrate a commitment to patient-centred care and improve the overall healthcare experience.

Digital survey data can be captured automatically and downloaded quickly without transcription error thereby saving time, reducing costs, and maximizing data accuracy.

For those patients who are not tech savvy, the staff can help the patient by using the paper survey forms and feed the data into the digital system.

As with paper surveys, digital surveys need to be designed well to be usable in practice and acting on the feedback and communicating the actions to patients is best service recovery method which every hospitals should strive for.

Currently, we are working towards increasing the response rate by creating awareness campaigns with posters informing patients of surveys and by increasing the frequency of emails with the survey links to the patients.

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Reference:
NLCAHR July 2016 | Rapid Evidence
Report: The Effectiveness of Digital Surveys for Patient Feedback

Robert G, Cornell, J. Bearley, S.et al. “What matters to patients?” Developing the evidence base for measuring and improving patient experience. Project Report for the Department of Health and the NHS Institute for Innovation and Improvement. 2011.

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