Hospital Reports - Advances in Cardiology Information Management System Design - Spacelabs Healthcar by Global Business Media

SPECIAL REPORT

Advances in Cardiology Information Management System Design Cardiology Information Management Systems Cardiology: The Opportunity of Big Data Big Data Revolution: Whatâ&#x20AC;&#x2122;s Standing in the Way Cybercrime and Healthcare The Future of Cardiology Treatment

Sponsored by

Published by Global Business Media

Published by Global Business Media Global Business Media Limited 62 The Street Ashtead Surrey KT21 1AT United Kingdom Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: info@globalbusinessmedia.org Website: www.globalbusinessmedia.org Publisher Kevin Bell Business Development Director Marie-Anne Brooks Editor Tom Cropper Senior Project Manager Steve Banks

Why CIMS? Building on the Past… … and the Opportunity Now Recent Advances Computing Devices and Your Access to the CIMS Patient Data, Analysis, Review, Workflow Capturing Data and Device Integration Sharing Data and EPR Integration Patient ID PDF Reports Order Communications EPR CIMS and Modules Network and Server Provision, Secure Connection Security and the Ability to Support Data Protection

Cardiology: The Opportunity of Big Data Turning the Tide How Data Can Benefit

Advertising Executives Michael McCarthy Abigail Coombes

Big Data Revolution: What’s Standing in the Way

Production Manager Paul Davies

The Digital Revolution The Skills Gap How To Make Data Work Moving to New Technology

For further information visit: www.globalbusinessmedia.org The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated. Material in advertisements and promotional features may be considered to represent the views of the advertisers and promoters. The views and opinions expressed in this publication do not necessarily express the views of the Publishers or the Editor. While every care has been taken in the preparation of this publication, neither the Publishers nor the Editor are responsible for such opinions and views or for any inaccuracies in the articles. © 2019. The entire contents of this publication are protected by copyright. Full details are available from the Publishers. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical photocopying, recording or otherwise, without the prior permission of the copyright owner.

Tom Cropper, Editor

Jo Roth, Staff Writer

Cybercrime and Healthcare

James Butler, Staff Writer

The Rise of Cybercrime The Rise of Ransomware Managing the Risks of Technology Closing the Gaps in the Fence

The Future of Cardiology Treatment

Tom Cropper, Editor

Next Generation Data Management Systems Integrated and Connected Mobile Health Artificial Intelligence

References 16

WWW.HOSPITALREPORTS.EU| 1

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

Foreword

n the digital world, data is fast becoming a much

Unfortunately, as Jo Roth explains, the sector has

sought after commodity, especially in cardiology.

moved more slowly than others. Legacy technology

It can improve turnaround times for tests, produce

and a fear of change stand in the way, as well as

faster and more accurate reports, and generate

cyber security. He’ll ask what steps organisations

insights which can lead to earlier diagnosis.

must take to make data work.

Unfortunately, the data management systems

James Butler, then looks at the most critical

of most organisations lack the sophistication to

issue with data: cyber security. Attacks have

capture and analyse all the data available. As a result,

risen dramatically over the past five years and

operations are less efficient than they could be, and

defences are not as good as they could be. He’ll

mistakes are made. When it comes to cardiology,

reiterate the importance of maintaining a good cyber

those errors can be fatal.

security strategy.

Our opening article comes from Spacelabs

Finally, we’ll look at the latest technologies which

Healthcare Ltd who outline some of the key issues

are shaping the future. Web access and mobile

the health service must confront when managing

technologies are changing the game and data itself

data. They explain what the latest technology can

is unlocking fresh innovation in the form of Artificial

do and how it helps health services overcome some

Intelligence. It’s an exciting world, which can help

of the obstacles which have been holding them back.

health services to continually improve care quality

Elsewhere in the Report we’ll examine the state of

while managing their costs.

cardiology. The costs are high and getting higher and, as health services struggle with finances, we face the real possibility that the quality of care may suffer. Health services are turning to data management to improve efficiencies and help them to do more with less.

Tom Cropper Editor

Tom Cropper, has produced articles and reports on various aspects of global business over the past 15 years. He has also worked as a copywriter for some of the largest corporations in the world, including ANZ Bank, ING and KPMG.

2 |WWW.HOSPITALREPORTS.EU

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

Cardiology Information Management Systems Spacelabs Healthcare, Diagnostic Cardiology and Remote Monitoring team

Why CIMS? A Cardiology Information Management System (CIMS) is able to provide considerable benefits in clinical practice, workflows, efficiency and secure handling of data. CIMS also meets the need for secure data management and continues to evolve, driven constantly by the wider IT industry. The essential requirement of a CIMS is in the capture and management of ECG data, analysis and reports, adding PDF reports from other Cardiology devices. ECG is managed as digital data from a number of devices which may come from different suppliers in addition to Holter, Stress, ABP and Event recording. The main benefit of a CIMS is in its support for workflow and data exchange between nurses, Cardiology practitioners and physicians, with digital ECG data available for interpretation, serial comparison and signoff procedures. Further PDF reports may be added from Ultrasound and Cath-lab, usually produced from device software geared to real-time use and mass storage such as PACS. Following data acquisition, a CIMS can then report data to Electronic Patient Records (EPR) systems for organisation-wide availability. The Cardiology department is then managed using the EPR facilities – for example, appointment booking – and the wider organisation has access

to Cardiology records as part of the integrated medical record. The coming years are likely to see wider adoption of CIMS in hospitals and clinics, across communities and linking services to EPR systems. This is driven by an increase in the expectation of well-organised and well-shared clinical records, supported by mature systems working in a united IT environment. In particular, access control and data security are shaping the requirement and providing reassurance of system-wide security across the scope of CIMS.

Building on the Past… Even though the need and the opportunities have existed for a long time, CIMS have probably not reached the level of uptake many healthcare professionals may have expected. Although many healthcare organisations use it successfully, some have only limited implementation and uptake. One challenge in the adoption of CIMS has been its ‘reach’ – as it embraces the delivery of clinical services, medical devices and information management. The definition and realisation of a system requires a creative and collaborative understanding across clinical and support specialities.

CONNECTIVITY OF A CIMS

WWW.HOSPITALREPORTS.EU| 3

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

The coming years are likely to see wider adoption of CIMSs in hospitals and clinics, across communities and linking services to EPR systems. This is driven by an increase in the expectation of well-organised and wellshared clinical records, supported by mature systems working in a united IT environment

ACCESSIBILITY OF A CIMS

There is also the balance of specialised software orientated to one type of device and the management layer which grows from that type of device. Both may integrate to a CIMS in a number of ways. And there are differences in the expectation of support and support cost. Devices with fixed functionality tend to have lower support needs and costs than software, and this can confuse budgeting. Finally informatics provision in general within the world Healthcare delivery has tended to lag behind the wider world of IT. This makes it challenging to engage some of the skills and resources which can help the process. Supplier organisations have to ensure they provide all the expertise to support the user’s needs.

… And the Opportunity Now Consumer technology has increased the level of customer expectation for all information management. It’s now natural to expect seamless working and total security from a CIMS. The needs and possibilities keep growing – such a system now needs to consider how it shares patient identities, detailed records, orders and results, how it may need to connect across local, community and international networks and how it meets the growing need for security as well as fast, efficient working. With recent developments in CIMSs, coupled with the need for complex data sharing and security, expectations are energising the need to overcome the historical challenges and complexities of the past. The key is to communicate the product capabilities and add more understanding to that 4 |WWW.HOSPITALREPORTS.EU

level of expectation early in any design process. We have to exploit recent advances in technology and use them to work across the relevant areas – particularly around deployment, support, access and data security. As we progress through this review, we will be identifying key factors in rationalising a new CIMS with today’s offerings. For each area, we aim to explain the issues and opportunities to each role – clinicians, biomedical engineers and IT.

Recent Advances A CIMS has a number of areas of value to the user: • Access – computing devices and your access to the CIMS. • Patient data, analysis, review, workflow. • Capturing data and device integration. • Sharing of analysed data – EPR connection. • How it meets regulatory standards such as Data Protection. The sections below go through each of these areas, looking at them within the context of: • Security needs and capabilities. • Supporting technologies. • Expectation of how a clinical IT system can be used. • Specification, implementation, delivery, and support. • Support for users in meeting their growing IT standards.

Computing Devices and Your Access to the CIMS The user’s experience of personal computing devices and services now sets a higher level of expectation for a clinical software system.

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

Web access supports this by making the CIMS readily accessible from many PCs and mobile devices around the key departments and organisation – Clinic, Doctor’s office or Ward. Smartphone and tablet access is moving on to become part of the organisation’s “mobile device environment” with built-in network security and centralised management of the devices. Increasing demand for access on handheld devices requires little effort on the part of the CIMS supplier – the web access is often all that is required, as the use of the device is managed as part of the local mobile device support system. Users can use the CIMS alongside other EPR features. The key factor in access to the CIMS is in how the user can be logged into the system. This authentication must use passwords, one-time passcodes or biometrics and be effectively policed by the system administrators. Multiple logins and passwords would make it complex and waste time and effort. Microsoft Active Directory has become wellestablished and provides the way to authenticate the user into multiple systems after a single login known as single-sign-on. The login and password are associated to common role definitions which are used within the applications. The sections below show the further exploitation of this and how it supports the user in meeting regulatory standards.

Patient Data, Analysis, Review, Workflow The classic ‘user functionality’ of a CIMS is around the review, comparison and reporting of patient data. Recent advances include: • The ability to capture and review 15- and 18lead Resting ECG. • The ability to capture ECG through PC-ECG modules and software. • Waveform views using increasingly highresolution graphics.

• Serial comparison across the ECG captured from multiple devices and device types. From initial capture of data through the stages of analysis, review, comparison and approval, the data needs to be presented to and accessed by multiple user roles, and shared with the correct users within the organisation. • General access to patient data may be controlled according to the user’s role and their organisation, controlling access to each individual patient or report. Controlling access to report level provides the maximum security and reduces any unnecessary view of tasks or data relevant to that user. • One of the key advantages of a CIMS is in its management of user workflow. In terms of task management, this controls the data each user can see and how the results are passed between users defined by their roles within the organisations. • This allows the data to be presented in a way which details a simple and clear list of tasks and provides access to patient data only when it is appropriate. • All this is based around the user’s identity, role and organisational status, which are known from the login and authentication, managed through Microsoft Active Directory, as described above. Recent developments come from the simplicity and dependability of login, authentication and role definition, and CIMS’ increased ability to manage access using that data. Users and support staff are increasingly familiar with IT and can feel the way to best practice.

Capturing Data and Device Integration CIMS easily capture data from devices which come from the same supplier with or without standard message formats, and the addition of partner devices is made simple with the use of data translation software. Providers of translation software are beginning to add

Scalable

From a single PC to a large multi-site network, Sentinel can be as big or small as you like... Using flexible licensing and software modules you can choose what is right for you now and modify your Sentinel installation as your needs change.

uksales@spacelabs.com + 44 (0) 1992 507 700 www.spacelabshealthcare.com

WWW.HOSPITALREPORTS.EU| 5

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

The first interaction of a CIMS with an EPR system is the capture of Patient Identity. This is necessary as every software system in a healthcare organisation must use one common identity or risk confusion over the correct data associated with that patient software dongles to simplify licensing in virtualised environments. Worklist transmission is being added to the capture of results. Again, realisation of a practical system without major reinvestment is becoming simpler. ECG machines or PC-ECG will usually be integrated with data in SCP, XML or DICOM format, with other devices most commonly using HL7 to deliver embedded PDF reports.

Sharing Data and EPR Integration The ability to share data with the EPR has been around for a long time, and recent advances are in the increasing maturity of EPR in more care settings and organisations. Coupled with expectations of technology, this encourages additional connection to a CIMS. All this is helped by the presence and expertise of the teams who build and support the EPR. The EPR will usually be a complete system with a module for the Cardiology department’s wider patient record needs. With the CIMS, this meets the need for the wider patient record with appointments and clinical documentation. The CIMS interacts with the EPR so as to share: • Patient identity and admission status. • Order communications. • Patient data and reports. User expectation drives all three of these areas. IT systems are expected to readily share information.

Patient ID The first interaction of a CIMS with an EPR system is the capture of Patient Identity. This is necessary as every software system in a healthcare organisation must use one common identity or risk confusion over the correct data associated with that patient. 6 |WWW.HOSPITALREPORTS.EU

A ‘complete’ EPR system has a Patient Administration System (PAS) function with a Patient Index, which is used in the admitdischarge-transfer process and is the source of truth for all Patient ID data held by that organisation. The complete EPR also manages clinical data, all within the same user interface. Some organisations have separate software systems for PAS and clinical records, with the tag ‘EPR’ being used only for the clinical side. And the clinical records may be simply a document management environment. In both cases, the PAS is the actual source of the Patient ID. Either way, there is a practical need to supply many specialised software systems with the unique ID and admission status. So the data – in the form of the HL7 ‘ADT’ message – is passed to another application known as an ‘integration engine’ (IE) which then feeds many systems. The receiving system does not need to know the original source.

PDF Reports The EPR system is the organisation’s established way to access patent record data, providing convenient, contextual information through a common user interface and common login. To allow the whole organisation to access Cardiology reports as part of the EPR, they must be passed from the CIMS to the EPR. This is done in the form of an HL7 ‘Result’ message, with Patient ID and the PDF report from the test.

Order Communications EPR users are able to place orders for tests using the EPR order communications service. For ECG, the orders are sent using another HL7 message, received by the CIMS or forwarded

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

to the ECG machine or mobile PC-ECG workstation. Either way, they are combined into a ‘worklist’ for that device, user, role and locality.

EPR CIMS and Modules As discussed earlier, the CIMS is a natural point for management of digital ECG data, and can be an economical way of communicating to the EPR through a single interface, depending on the cost and support on the EPR side. The CIMS can also be a module within the EPR provision, bringing common UI and login and requiring device integration which may come from external CIMS functionality. Or, a CIMS can communicate with another CIMS to support and add to existing provisions or by way of gradual migration from one to another.

Network and Server Provision, Secure Connection Server implementation has become simpler with increasing server and network virtualisation and flexible storage resources, supported by secure network protocols.

Security and the Ability to Support Data Protection Standards Security now has a higher profile and a greater degree of acceptance than ever before. Healthcare organisations have the highest need for secure management of personal information. Many have suffered from cyberattacks which have disabled their ability to maintain their service. The laws around personal data are very clear – data security is now imperative throughout the CIMS lifecycle. As with so many items discussed above, there is now wider understanding of security issues. Typical international needs are shown below. Most recently, GDPR data protection standard was introduced in the CE-mark area. • For user authentication, required capabilities include the ability to work effectively with Microsoft Active Directory to achieve user

single-sign-on. This includes password standards such as complexity, automatic deactivation under a range of conditions, and manual deactivation or replacement. • For role-based access, requirements should include authorisation profiles for user roles and organisational status, managed by a system administrator. These need to pervade the application for all access and workflow. The customer should set up and maintain their own user profile definitions and configurations. • CIMS are required to meet encryption standards for data held at rest and in transit – during exchanges between database, web-server and client, and during import and export. They need to keep an audit trail of user and attempted user activity. • CIMS suppliers need to work with their customers to meet the changing data security requirements. The suppliers themselves cannot ‘meet’ these requirements, as the final implementation has dependencies on how the system is configured and deployed. The organisation will be the “data processor” or “data controller” and will need to define and achieve its required level of compliance. • CIMS suppliers require system implemention processes and procedures to ensure they comply with their own internal obligations. They must control access or share data only when assured that the partner will also comply. • CIMS managers must ensure that their users are trained and aware of their obligation under the relevant implemented internal policies and how they are realised in practice. Finally, the CIMS supplier needs to provide support to the customer during installation and maintenance, to make for a secure, efficient and effective project. The system will be usually implemented within the customer’s IT infrastructure, so the precise role of each participant is understood in terms of data access, storage and responsibilities in line with the local laws on Data Protection.

Security now has a higher profile and a higher level

Accessible

Meeting the clinical need to access multiple diagnostic tests... With Sentinel you can manage patient data using most web browsers on a PC, tablet, or smartphone and upload data to your EMR system for even greater access.

of acceptance than ever before. Healthcare organisations have the highest need for secure management of personal information, and many have suffered from cyber-attacks which have disabled their ability to maintain their service

uksales@spacelabs.com + 44 (0) 1992 507 700 www.spacelabshealthcare.com

WWW.HOSPITALREPORTS.EU| 7

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

Cardiology: The Opportunity of Big Data Tom Cropper, Editor Heart disease is the nation’s biggest killer, but health services constantly miss chances to improve outcomes. Can big data plug the gap?

Financial restrictions leave us with the unpleasant prospect of reversing decades of sustained improvements in health care as it simply becomes unaffordable

8 |WWW.HOSPITALREPORTS.EU

EART DISEASE is the world’s biggest killer. In the UK it accounts for one in four of all deaths, and 45% of all deaths in Europe (3.9million a year)1. It is also an enormous drain on health service resources. In the US, estimates suggest it costs £200bn a year in terms of healthcare provisions, medications and lost productivity2. In the EU that figure stands at e210bn3. Despite improvements in healthcare, the impact of heart disease has increased over the past decade. An aging population, urban living, poor diets and a lack of exercise all push more and more people into the high-risk zone. A study by RTI International for the American Heart Association warns that, if left unchecked, the number of Americans living with Cardiovascular Disease (CVD) could rise to 45% of the population by 2035 with total cost predicted to reach $1.1 trillion4. The authors of the report warn that, if things are left unchecked, the impact on the nation’s health and economy could be profound. Within the next decade, the cost of healthcare as a proportion of GDP could approach 20% 5. Governments need to inject enormous amounts of capital into health budgets simply to maintain standards at similar levels. Financial restrictions leave us with the unpleasant prospect of reversing decades of sustained improvements in health care as it simply becomes unaffordable. We may be seeing some of the signs already. Life expectancy in the US has fallen for three years in a row according to the BMJ6. In the UK the Institute of Faculty of Actuaries found that life expectancy had fallen by six months, warning its findings indicated a trend rather than a blip7. Many have been quick to link this to austerity which has seen funding for the NHS stall. Despite promises of more money from governments, resources are finite and services are having to operate in a more cost constrained way.

Turning the Tide There is hope. Mortality rates have fallen for heart disease, even if the absolute number of cases is rising. Even so, figures suggest there is considerable room for improvement. Research from the University of Leeds found that almost a third of patients are being misdiagnosed. The study looked at NHS data over the course of nine years covering 243 hospitals and more than 600,000 heart attack cases. In around a third of all cases, (198,534) patients were initially misdiagnosed8. What’s more, women were 50% more likely to have a different initial diagnosis from their final diagnosis. Part of the reason is a misunderstanding of the data. Heart disease is the number one cause of death among women, but even medical professionals often falsely believe it to be breast cancer. Indeed, heart disease is even a leading cause of death among women with breast cancer. Women tend to present with different symptoms from men. Because our understanding of heart disease revolves around male bodies and male symptoms, both clinicians and patients themselves often fail to spot symptoms in women until it is too late.

How Data Can Benefit Oddly enough, this can be seen as a positive. By making adjustments, which should be possible today, health services can improve significantly the provision of cardiology services in a relatively short space of time. Data management sits at the heart of this issue. If health services can get a better grasp of data, they can unlock numerous insights which could address issues of gender and racial bias in diagnosis. Systems, for example, could issue warnings or guidance based on the information contained within a patient’s medical data. These insights can also be used to provide analysis of operations and improve service delivery. For example, an effective data

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

ABP

management team can take information generated by the treatment pathway to produce learnings and improve efficiency. On a more mundane level, data management can improve operational efficiency, reducing waste and saving money. Services which have upgraded their data management systems have seen a number of benefits including: •F aster reporting times: Clinicians can quickly compile daily, weekly and even monthly reports with just a few ‘clicks’. •R educed administration errors: Data entry can be automated and synchronised across the system which reduces the risk of human mistakes. •L ower administrative burden: Old fashioned data management systems could be cumbersome and time consuming. Going digital takes less time and frees staff up for more valuable tasks. •M ore efficient workflows: Workflows can be harmonised across departments leading to clearer and more streamlined activity.

Almost every process stands to benefit, providing multiple incremental savings which add up to a substantial gain. Unfortunately, obstacles stand in the way. Health services have proved to be difficult in transitioning towards new high-tech IT systems. Old habits die hard and many departments are resistant to change. For some it’s a case of lacking the expertise to make use of data or to develop new IT systems. For others it’s a concern about the risks presented by cybercrime. Some will simply be reluctant to move on from systems with which they are familiar and have been working with for some time. Whatever the impediments, this is a change health services need to make. The world is going digital and better data management opens up so many opportunities that are hard to ignore. Change must come across the entire organisation, not just single departments. Data must be shared and made available to all those who need to use it. Only in this way can health services harness the power of data and digital technology to equip them for the future.

Sentinel can configure your Spacelabs ABP device, capture the data in the patient record, and securely share the analysis across your hospital network and beyond.

Data management sits at the heart of this issue. If health services can get a better grasp of data, they can unlock numerous insights which could address issues of gender and racial bias in diagnosis

uksales@spacelabs.com + 44 (0) 1992 507 700 www.spacelabshealthcare.com

WWW.HOSPITALREPORTS.EU| 9

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

Big Data Revolution: What’s Standing in the Way Jo Roth, Staff Writer The health sector has struggled to embrace all the benefits big data can bring. How can it turn things around?

In 2011, the NHS abandoned an ambitious IT project to create a computerised patient record system across the NHS. Even now, the health services struggle to share patient data across different departments

10 |WWW.HOSPITALREPORTS.EU

ATA ANALYTICS have the potential to transform the quality of healthcare in all areas, but especially in cardiology. Improvements here will mean patients can expect to live longer and fewer people will require long term emergency care. The goal is relatively simple: to create a seamless and easily accessible patient record in which data is collected and shared across the entire health continuum. Unfortunately, making that happen is anything but.

The Digital Revolution Governments have been keen to promote the digitisation of health services. The NHS long term plan sets out its ambitions over the next decade. It focuses heavily on technological developments pushing towards progressive digital transformation across the entire health spectrum - but progress so far has been patchy. A plan to become paperless by 2019 was missed by a mile and health services still struggle to embrace any digital innovation. Data is a perfect case in point. In 2011, the NHS abandoned an ambitious IT project to create a computerised patient record system across the NHS. Even now, the health services struggle to share patient data across different departments. The problem is that, until now, improvements have been piecemeal. As a report into the use of IT in cardiovascular care states: “small, isolated problems are solved in a single, non-integrated manner, with a single solution developed for a single problem. Each solution is developed typically by a single commercial vendor, mostly using proprietary equipment and software. As time passes, what results is an enormous confused mess of isolated, stand-alone systems, each unable to communicate with the others (or, at best, only with a few others)9.” Data may be collected and produced, but it is not being analysed. It is unstructured, disorganised and fails to provide real benefits.

The Skills Gap Audits taken by the Healthcare Quality Improvement Partnership (HQIP) comparing hospital and physician outcomes and implementation of the National Institute of Clinical Excellence (NICE) Standards across England, showed a gap in data analytics. Speaking to the Guardian, HQIP Dr Danny Keenan admitted that, although they have the expertise to do the analytics, they are “woefully inadequate at translating such analysis into improvements. What’s the takeaway for the hospital or community provider board or medical director? They cannot understand what they have to do10.” Healthcare is not the only sector to suffer from a personnel problem. Big data is still an emerging discipline and analytics professionals with the specialist expertise to turn data into insights are in short supply. When applying that expertise to the health service, the shortage becomes even more acute. Health services will need to turn to their training and recruitment processes to try and plug the talent gap. The problem isn’t made any easier by the difficulty of integrating technology and making it more widely available. To be effective, data must be accessible by multiple organisations operating in many different locations. However, different departments may move at different speeds either because of attitudes, ingrained technological infrastructure or a lack of expertise and experience. Concerns about cyber security also hold them back. Cybercrime is rising and criminals are increasingly targeting health services. Not only do they handle large quantities of sensitive information but maintaining an effective cyber security strategy across multiple departments is extremely difficult. Gaps in the defences are everywhere and as breaches against the NHS, individual hospitals and health insurers show, criminals are finding them.

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

ECG How To Make Data Work All these concerns are very real, but rather than acting as an impediment, they should be seen simply as additional considerations which departments will need to take into account when choosing data management systems. In the first instance, it’s about creating a longterm plan and developing a comprehensive strategy to improve the cardiovascular department with a superior IT infrastructure. It’s about taking a more enterprise-led approach in which applications such as hospital information systems, electronic medical records and a cardiovascular information system leads to better workflow efficiency and data analytics. The choice of data management system will be vital. It needs to provide visibility across all departments taking data from multiple sources and presenting it in a single central location which can be accessed easily by all participants who need it and have the appropriate permissions. Data may need to be translated from different forms and presented in a clear, unified way.

Moving to New Technology Transitioning to new technology may not always be straightforward. If an individual department still relies on paper-based reporting, for example, it may need a separate strategy to make a frictionless transition to join in with new reporting methodologies.

Technology needs to be flexible and mobile. Workstations may need to be taken around a hospital to be used at the bedside where care is being given. It could include provision for access in a more private setting or even in the home. Remote and mobile working will help to capture data from the point of care taking it into a universally visible central repository which can be instantly updated. Increased web access and smartphones makes this much easier. Web-based platforms free users up to connect remotely from smartphones, tablets or PCs allowing them to use data wherever they are. This mirrors the enterprise data systems of leading businesses and leads to more flexible working and a faster flow of data. This approach can increase the effectiveness while also driving down costs. There is less infrastructure to purchase and less chance that it will be difficult to implement with existing systems. It is everything the health service needs – mobile, flexible, agile and able to facilitate the flow of information across multiple departments. Operations become more efficient and outcomes improve. On the downside, though, this can increase an organisation’s exposure to cybercrime and this is an issue which needs to be addressed before anything else. We’ll explore this in more detail in the next article.

Sentinel can provide worklists, capture and compare your patient’s ECG trace from almost any ECG machine, and securely share the confirmed results across your hospital network and beyond.

The problem isn’t made any easier by the difficulty of integrating technology and making it more widely available. To be effective, data must be accessible by multiple organisations operating in many different locations uksales@spacelabs.com + 44 (0) 1992 507 700 www.spacelabshealthcare.com

WWW.HOSPITALREPORTS.EU| 11

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

Cybercrime and Healthcare James Butler, Staff Writer Cybercrime is a fact of life, so as health services become more adept at using technology, they must ensure all data is kept safe.

Health services represent attractive targets because they handle large amounts of sensitive information such as names, addresses and bank details, and gaps often exist in defences.

EALTHCARE IS going high tech, but that puts it in the line of fire of cyber-criminals. If digital technology is to truly take off, it needs to find a way of providing seamless access to data while ensuring that all patient data is kept safe and that organisations can comply with the latest data protection regulations.

The Rise of Cybercrime Cybercrime is rising across the board. It has become a multibillion-dollar industry and threatens just about every part of the business world. Over the past five years we have seen cyber criminals increasingly turn their attention towards healthcare. According to a threat report issued by endpoint security provider, Cylance, health service providers are attracting more cyber-attacks than any other sector11. Health services represent attractive targets because they handle large amounts of sensitive information such as names, addresses and bank details, and gaps often exist in defences. Attacks come not only from criminals looking for financial gain, but also from hostile nation states and so-called hacktivists whose goals are political rather than financial. A 2015 attack on the US health insurer, Anthem, saw hackers steal 78.8 million patient records containing sensitive data including names, addresses and social security numbers. Investigations revealed that a nation state had been behind the attack although it declined to name it12.

The Rise of Ransomware Health services are also vulnerable to denial of service attacks and ransomware. These shut users out of their systems and demand payment, usually in bitcoin, to restore a connection. This is the fastest growing area of cybercrime and recently passed the $2bn a year mark13. The most high-profile attack came in the form of the Wannacry virus which, in 2017, attacked organisations around the world including the NHS in the UK. It crippled computers across the NHS, forcing the cancellation of surgery and 12 |WWW.HOSPITALREPORTS.EU

appointments. All in all, it is thought to have cost a total of ÂŁ92million14. A breach in healthcare data is especially serious because it often means the difference between life and death. In a data-driven world, clinicians rely on shared information about a patient to shape their treatment plans. In cardiology, for example, healthcare providers are increasingly aggregating data from multiple sources to guide care teams in the treatment process. If that data is lost or altered, the consequences could be catastrophic. Without it, medications could be mixed up, clinicians may receive incorrect information which could lead to serious errors in treatment.

Managing the Risks of Technology Risk management must be a key part of any technological innovation, especially with the arrival of Europeâ&#x20AC;&#x2122;s General Data Protection Regulations (GDPR). GDPR places a greater onus on those handling personal data to ensure it is safe, reports breaches and gives individuals a greater say in how their data is managed. Patients must be informed about how their data will be used, how long it will be stored and give their active and informed consent. If they wish their data to be modified or deleted, an organisation must be able to comply quickly. If a breach does occur, data processors will have to inform relevant authorities. Failure to do so could incur a fine of up to e20million or 4% of annual turnover. However, GDPR should also be seen as an opportunity. Because it requires organisations to take greater control of their data, these regulations, alongside appropriate support from technology suppliers, make data more visible and usable. Not only will it be easier for organisations to comply with their regulatory obligations, but they will be able to utilise data and gain insights to improve the quality of care they can provide.

Closing the Gaps in the Fence Technology, then, is crucial, but it must come

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

Secure

hand in hand with a comprehensive cyber security strategy. To achieve this, the health service needs to adjust its mindset. Data security should become an organisation-wide priority rather than just being a function of the IT department. Any system which shares data must ensure it is fully encrypted and that permissions are carefully monitored and controlled. All devices used to access the systems (or endpoints) must be fully secured and access from any unsecured device prohibited. The choice of partner organisation will also become much more important. Gaps in their defences could create problems for health services. Those which can show the highest levels of data custodianship will offer much more value than those whose own strategies are vague or incomplete. Most of all, health services must establish a security culture in which best practice is embedded into the entire organisation hierarchy and all employees follow best practice. Every employee, from the most senior managers to part time administrative staff, must be aware of the evolving threats and made to follow clear procedures regarding downloads of software, accessing systems and managing passwords.

Even the most sophisticated attacks rely on human error to get past defences. Finally, a good defence strategy should also put in place disaster recovery protocols. Cyberattacks are proliferating rapidly. Sooner or later a breach will happen, but what matters most is how an organisation responds. Health services are putting measures in place to detect attacks as soon as possible and ensure operations can continue even if systems go down. Surgeons, for example, are increasingly being trained to work around attacks. Imagine a ransomware attack locked them out of critical devices during surgery. They would need to be able to work around it to safeguard the safety of their patients as much as possible. Cybercrime complicates matters. Itâ&#x20AC;&#x2122;s a new and evolving threat that health services are only gradually coming to terms with. Defences are improving, but criminals never stay still for long. The future will be marked by a neverending game of cat and mouse between the two sides. The stakes are incredibly high and, although technology does bring benefits, it also increases exposure. When choosing IT vendors, therefore, security should be right at the very top of the list.

Developed with security at the core...

Sentinel provides encryption, secure network connections, password authentication and audit trails to keep your patient records safe.

Health services must establish a security culture in which best practice is embedded into the entire organisation hierarchy and all employees follow best practice uksales@spacelabs.com + 44 (0) 1992 507 700 www.spacelabshealthcare.com

WWW.HOSPITALREPORTS.EU| 13

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

The Future of Cardiology Treatment Tom Cropper, Editor Digital technology has already transformed our world, but the good news is that there is much more to come. The key to all this is data.

Approximately 90% of all data ever created came into being over the course of the last few years. The next five years could see a further explosion of data. International Data Corporation (IDC) expects to see 175 zetabytes of data by 2025, an increase of 61% over today’s levels

HE FUTURE of cardiology is in digital. Innovations such as mobile health, artificial intelligence (AI) and analytics can transform the delivery of healthcare to patients. The fuel for all of these is data and, as the health sector gets better at data management, it can develop increasingly sophisticated and advanced technology. However, as health services step up their investments in digital technology, they need to ensure that the money is well spent.

Next Generation Data Management Systems We are living through the big data century. Approximately 90% of all data ever created came into being over the course of the last few years. The next five years could see a further explosion of data. International Data Corporation (IDC) expects to see 175 zetabytes of data by 2025, an increase of 61% over today’s levels15. The care journey generates data at multiple points and, with the rise of digital technology, the amount of usable data is increasing all the time. That information could be used to improve insights into the onset of diseases and promote better decision making, but, despite all of this, we still don’t know much more than we did before. The problem is that existing data management systems aren’t capable of handling all this available data. It’s there, but we don’t know what to do with it. All too often, the focus has been about data quantity rather than quality and management. Managers end up seeing huge amounts of data on the screen, but not being able to derive any information from it. It’s a case of not seeing the wood for the trees, so the emphasis must switch to next generation data management solutions which can aggregate data from multiple sources and present it in an easy to use format.

Integrated and Connected A key barrier to data management is the segmentation between different departments.

14 |WWW.HOSPITALREPORTS.EU

All too often innovation has been focused on individual tasks and specific applications. Advances happen in isolation where they need to be part of an integrated system-wide application which allows sharing of data across the entire spectrum of healthcare. At the same time, integration often presents a problem. Legacy infrastructure can be expensive and risky to replace. Managers will be reluctant to replace any IT systems which are perceived to be functioning well in favour of unproven updates which could create unforeseen problems upon installation. Next generation solutions offer ways around these problems. For example, Blue Button in the US allows patients to view their medical records online and download them. Patients Know Best does something similar in the UK giving people control over their medical records and who can view them. This helps them to connect with medical professionals around the world and ensure that, every time they see a new medical professional, they can have access to their complete medical history. For care teams, advanced data management solutions such as Sentinel 11, offer a way to gather all that data from multiple sources and present them in a clear and easily understood way. It is a web-based platform which can collect information from a broad range of cardiology monitoring systems to display it all in a single location. It is highly configurable allowing all information to be viewed remotely saving time and offering greater flexibility. Sentinel 11 offers a single interface which provides a highly secure platform for instant analysis. All information is encrypted within a secure network in transport, workstations, and in web and data servers. From there users can connect with all cardiology modalities using Active Directory and connecting to the EHR to give cardiologists a complete view of a patient’s health and medical history.

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

Holter

Mobile Health Platforms such as these will become increasingly pivotal as technology starts to harvest useful information from more locations. This is especially useful with the rise of mobile health apps which help patients to self-monitor and can identify problems much earlier. They help to shine a light on what is often referred to as the ‘silent epidemic’ of heart disease. Smoking, drinking and poor diet may cause obesity, hypertension and elevated blood glucose levels, all of which may lead to heart disease. The earlier this can be detected, the easier and cheaper the patient will be to treat, but these will need to be constantly monitored. Devices such as health sensors and fitness apps can help to adjust lifestyle and keep track of fitness levels. Easy to use devices, combined with AI, could provide advice, promote positive lifestyle changes and issue warnings at an earlier stage. They increase the amount of data available which, if it can be stored centrally, can inform clinicians when making a decision. Using mobile health (mHealth) devices linked with other data such as electronic medical records, a clinician will have much information about the individual’s health. This will help them to make an earlier and more accurate diagnosis, which

should translate into improved outcomes and lower mortality rates.

Artificial Intelligence Better data management can also add fuel to other technologies such as AI. This is one of the most exciting and innovative areas of healthcare but it needs vast amounts of data. A big data approach can provide millions of individuals’ electronic health records to collect data in high volume, veracity and velocity. By merging and harmonising these data sets, researchers can develop algorithms which help them develop more effective personalised cardiovascular disease (CVD) treatment plans. The more data health services collect and the better they become at analysing it, the more sophisticated AI algorithms can become. This opens the door to a whole new generation of technologies at which data is the heart. Effective management allows health services to do more than just improve treatment pathways, it facilitates and empowers a host of exciting innovations which can improve care in ways which we will not be able fathom as yet. Data, therefore, holds the keys which can unlock a more sophisticated, effective and high-tech future.

Better data management can also add fuel to other technologies such as AI. This is one of he most exciting and innovative areas of healthcare but it needs vast amounts of data

Sentinel can configure your Spacelabs Holter device, capture the data in the patient record, and securely share the analysis across your hospital network and beyond.

uksales@spacelabs.com + 44 (0) 1992 507 700 www.spacelabshealthcare.com

WWW.HOSPITALREPORTS.EU| 15

ADVANCES IN CARDIOLOGY INFORMATION MANAGEMENT SYSTEM DESIGN

References: European Cardiovascular Disease Statistics: http://www.ehnheart.org/cvd-statistics.html

1 2

Heart Disease Fact Sheet: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm

Cardiovascular Disease in Europe, The Unfinished Agenda: https://www.scitecheuropa.eu/cardiovascular-disease/90638/

Cardiovascular Disease Costs Will Exceed $1trillion: https://www.sciencedaily.com/releases/2017/02/170214162750.htm

Healthcare Spending Could hit 19.4%:

https://www.modernhealthcare.com/article/20190220/NEWS/190229989/healthcare-spending-will-hit-19-4-of-gdp-in-the-next-decade-cms-projects 6

US Life Expectancy Falls for Third Year in a Row: https://www.bmj.com/content/363/bmj.k5118

Life Expectancy Slumps by Six Months: https://www.theguardian.com/society/2019/mar/07/life-expectancy-slumps-by-five-months

A Third of Heart Attack Patients Misdiagnosed:

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/behind-the-headlines/misdiagnosis 9 10

Information Technology Data Standards: https://www.uscjournal.com/articles/information-technology-data-standards Another NHS Crisis Looms: An Inability to Analyse Data:

https://www.theguardian.com/science/political-science/2017/feb/08/another-nhs-crisis-looms-an-inability-to-analyse-data 11

Healthcare Sector Takes Brunt of Cyber Attacks: https://healthitsecurity.com/news/healthcare-industry-takes-brunt-of-ransomware-attacks

New In depth Analysis of Anthem Breach: https://www.bankinfosecurity.com/new-in-depth-analysis-anthem-breach-a-9627

Ransomware Now a $2bn a Year Industry: https://www.cyberscoop.com/ransomware-2-billion-bitdefender-gpu-encryption/

Wannacry Cyber Attack Cost the NHS Â£92million:

https://www.telegraph.co.uk/technology/2018/10/11/wannacry-cyber-attack-cost-nhs-92m-19000-appointments-cancelled/ 15

IDC: Expect 175 Zettabytes of Date by 2025:

https://www.networkworld.com/article/3325397/idc-expect-175-zettabytes-of-data-worldwide-by-2025.html

16 |WWW.HOSPITALREPORTS.EU

Hospital Reports The leading specialist combined online research and networking resource for Doctors, Clinicians, Specialists, Consultants, Surgeons and other Senior Medical Professionals and Executives within both Public and Private Hospitals.

• Up-to-the-minute unparalleled depth of information on specialist subjects available to all site users on a free of charge open access basis. • Qualified signed up members are able to access premium content Special Reports and interact with their peers using a variety of advanced online networking tools. • Designed to help users identify new technical solutions, understand the implications of different technical choices and select the best solutions available. • Thought Leadership – Advice and guidance from internationally recognised key opinion leaders. • Peer Input – Contributions from senior healthcare professionals. • Independent editorial content – Expert and authoritative analysis from award winning journalists and leading healthcare commentators. •

Unbiased supplier-provided content.

•

Designed to facilitate debate.

•

Written to the highest professional standards.