Emerging Technology

The medical doctor who heads the consulting giant’s global health practice foresees AI having a huge impact in healthcare this year, and is keeping his eyes on blockchain, extended reality and quantum computing.

Ransomware, coupled with an expanded attack surface thanks to a proliferation of internet-connected medical devices, are among the top security concerns health players should be concerned about in 2020. Additionally, a troubling new trend of attacking automatic software and firmware update systems, as highlighted in March 2019’s "Shadowhammer" attacks, is another vector for malware that can be hard to protect. These trending risks are particularly important due to the proliferation of new medical technologies and because often with these technologies the stakes are higher. "Ransomware will continue to be the biggest issue as attackers have seen the urgency they can create that can lead to payment," Dr. Saif Abed, CEO of Clinical Cyber Defense Systems, told HealthcareIT News. "Attacks will become more frequent and indiscriminate." He predicted the "zero trust" approach would emerge as a key strategic approach, an IT security model that requires strict identity verification for every person and device trying to access resources on a private network, regardless of whether they are sitting within or outside of the network perimeter. "The reality will be focusing on the basics," he said. "Know what and who are connecting to your network, identify vulnerabilities and have a patching strategy." He noted that while much is made of the security issues surrounding medical devices it’s much bigger than that as far the broadening of the attack surface. "Interoperability coupled with increasing M&A activity in healthcare will be larger driving factors that attackers will exploit," he said. "Unpatched IoT endpoints, whether they’re medical devices or not, will simply contribute to the porosity of networks and the ability to move laterally to maximize harm." He explained most attackers exploit simple vulnerabilities and, unfortunately, these continue be pervasive.. "Health systems are gradually improving with more leadership in the space but far greater investment is needed in people, processes and technology to get most where they need to be," Abed said. Mounir Hahad, head of Juniper Threat Labs at Juniper Network, told HealthCareITNews he believes ransomware would continue to pose a significant risk to many verticals, with healthcare "very near the top" of that target list. "This is because attackers know there are lives at stake in an industry where cybersecurity is not a primary concern for most users--practitioners and staff," Hahad explained. "This makes them an easier target for social engineering attacks and also a wealthy target that cannot withstand long downtimes." KnowBe4 security awareness advocate Erich Kron predicted that until industries can disrupt the income being generated by ransomware, the threat would continue to grow. "The healthcare industry is especially vulnerable due to the need for timely access to medical records for treatment, the amount of sensitive data being collected and the threat of substantial fines for non-compliance and data breaches," he noted. "The attackers know this and use this to their advantage." Kron said the biggest threat to healthcare he sees evolving in 2020 is the threat of exfiltrating and then leaking data when organizations fail to pay the ransom. He explained that in the past, a good backup strategy, offsite copies of data and the ability to quickly restore data have been enough to avoid paying the ransom. "However, with the threat of data being exposed, these steps, no matter how well executed can still end up with disastrous consequences," he said. "Just the fact that they attackers can exfiltrate data and have the keys to decrypt it will be a major concern with respect to HIPAA violations in future events."  Meanwhile, cellular 5G technology will allow a much larger proliferation of IoT medical devices as we enter 2020, and the security implications of this are enormous. "A lot of processing of information will move closer to the edge of networks and will be disaggregated for scale and performance, shining a light on new attack surfaces," Hahad explained. Kron pointed out that as more equipment is introduced to hospital networks, the ability to monitor, patch and secure devices becomes exponentially more difficult. "In addition, the increasing complexity of connected equipment significantly raises the stakes with respect to failures in these areas," he said. "Not only do we need to be concerned about taking a connected pump offline or disrupting monitoring stations, we are also having to concern ourselves with securing immensely more complex systems such as surgical robots." Nathan Eddy is a healthcare and technology freelancer based in Berlin. Email the writer: nathaneddy@gmail.com Twitter: @dropdeaded209

Improvements in patient outcomes and population health will be enabled as a culture of data-driven decisionmaking takes root and quality improvement processes mature.

These trends are good news for provider organizations looking to improve care, gain efficiencies and trim costs, an InterSystems vice president predicts.

The chief medical officer and co-founder at patient engagement tech vendor Luma Health provides a view of what provider organizations can expect in the year ahead.

Artificial intelligence will also continue to be a big focus, as it becomes more clear which startups are succeeding in their initial target sectors. VCs are also eyeing genomics analytics tools, as well as other more practical technologies.

While there is a large and growing market for remote patient monitoring technologies, with particular benefits for the older population, simplification of connection technologies – Bluetooth for one – will be key to the broader adoption of RPM in 2020. The vast majority of hospitals and health systems – 88 percent – have invested in or plan to invest in remote patient monitoring technologies as part of their transition to a value-based care model, according to a 2019 Spyglass Consulting report. Smartphones and tablets are among the mobile technologies in focus, which can be combined with telehealth video conferencing and healthcare wearables, as well as the deployment of electronic health record-based patient portals. "There are now numerous RPM solutions out there, including a select few that have had very positive outcomes toward meeting the quadruple aim – improved patient experience, improved clinical experience, better outcomes and lower costs," Eric Rock, CEO of Vivify Health, a provider of connected healthcare delivery solutions, told Healthcare IT News. He noted there has also been a shift to greater commitment to value-based care and improved home care, especially from government-led initiatives which new RPM reimbursements have helped to drive. "As we see it, 2019 was kind of the trial run or dress rehearsal for RPM reimbursement; 2020 will be the culmination of all those efforts," he said. "It is all these waves that will combine in a perfect storm for RPM in 2020." He noted, however, that a basic, narrowly focused app that only connects to a limited number of devices has been shown to be insufficient to accomplish large-scale cost reductions and improved health. "What's necessary is a multi-condition platform driven by engaging content and a clinical backend that scales population health delivery," Rock said. "We need apps that can handle multiple conditions across a wide range of devices to fulfill the true potential of RPM while remaining affordable." He said those devices must also have intelligence built into them to help filter all this incoming data and guide providers or care coordinators to activities or events that requires their attention – otherwise, the data becomes noise to providers and it gets ignored, similar to alert fatigue with EHRs. "All of this must also be connected to the existing healthcare infrastructure including security and communications standards such as HIPAA and HL7," Rock explained. "If we can do all of that, and I believe it's possible in 2020, we will change healthcare – and change lives." Harry Soza, CEO of CAREMINDr, Silicon Valley tech company that partners with health plans and providers to advance population health management through RPM, said he sees potential for "significant growth" in RPM in 2020. "We have clients that are beginning rapid, large scale expansion of their RPM programs after having run smaller pilots during 2019," he said. "This type of expansion absolutely requires specialized monitoring systems, because RPM care is fundamentally different from the traditional methods of providers interacting with patients." Soza said RPM requires a "fundamental change" in how a provider system organizes itself and its relationships with patients, because it is non-face-to-face, and requires a patient to become a responsible, engaged partner with their doctor – which brings new types of challenges related to the business of delivering care. "Many of the barriers hindering expansion of RPM programs can be solved through a blend of business management and new technology approaches," he explained. "Acceleration in adoption can only occur when the systems being implemented are easy for provider groups to adopt, but also comprehensive as related to their business needs. This is the largest challenge in the RPM industry today." Nathan Eddy is a healthcare and technology freelancer based in Berlin. Email the writer: nathaneddy@gmail.com Twitter: @dropdeaded209

An expert at AI-based cloud fax tech vendor Concord Technologies offers his look ahead at the year – focusing on AI, cybersecurity and interoperability.

Vendors offer their perspective on the opportunities and challenges for healthcare data exchange in the year ahead.

Healthcare information technology will be the focus of investors in 2020, with interest in the pharmaceutical and biotech sector, home and hospice care and managed care companies also high on the list, according to a KPMG report including survey results from 333 investment professionals. WHY IT MATTERS The study projected the healthcare and life sciences industry would likely continue to be an attractive investment target for the foreseeable future, as national healthcare spending rises to $6 trillion by 2027. Overall, more than three-quarters (76%) of respondents thought the health IT market would grow faster than the overall healthcare and life sciences market. Healthcare analytics, cloud-based EHRs and workflow applications, revenue cycle management software, and telemedicine are among the IT products of greatest interest to investors. The medical technology space, which includes precision medicine, robotics and smart wearables, is expected to continue to grow at a pace of more than 5% per year, with annual sales worldwide expected to reach $800 billion by 2030, according to KPMG. Indeed, robotic surgery is one of the main potential areas of investor focus in 2020, alongside AI-enabled devices, while in the more classic medical device segment, the robotic surgery market is expected to continue to attract M&A interest. As artificial intelligence and robotic process automation are more widely deployed, they will help re-humanize medicine by allowing doctors to focus less on paperwork and administrative functions, and more on patient care. In the area of revenue cycle management, KPMG's report urged investors to look for technologies that facilitate one patient experience continuum from scheduling to treatment to billing. When it comes to home health and hospice care, potential investors are looking for firms that provide a spectrum of services across nonmedical home care that range from activities of daily living and basic home healthcare for the transitional period after a hospital or rehab stay, all the way to home hospice scenarios. THE LARGER TREND Despite the demand for investment in healthcare IT innovators, a study released earlier this week indicates health systems don't always make good use of the technology they already have in place. A Black Book survey of 748 providers organizations found the vast majority of them are failing to meaningfully integrate data analytics into their clinical and operational workflows, despite widespread availability of the technology. ON THE RECORD "We believe we are entering a very exciting time for investment in healthcare and life sciences," the report concluded. "Despite unknowns related to the 2020 election and uncertain industry regulatory challenges, there are significant investment opportunities across the industry." The report predicted these opportunities would continue to gain momentum in 2020 due to multiple factors, including the push towards consumer-centric care delivery and connected medical devices, as well as new models of vertical integration, and consolidation for scale and efficiencies. Nathan Eddy is a healthcare and technology freelancer based in Berlin. Email the writer: nathaneddy@gmail.com Twitter: @dropdeaded209