May 17, 2020

Emergency preparedness for the modern era

Hospital Operations
Emergency Preparedness
Miami Children's Hospital
Lucile Packard Children's Hospital
5 min
Climate change affects a hospital’s functionality and a staff’s ability to deliver health care.
Its nothing we havent heard before—global climate change is a major and unprecedented public health threat, and its only getting worse.

Unlike in...

It’s nothing we haven’t heard before—global climate change is a major and unprecedented public health threat, and it’s only getting worse.

Unlike infectious pandemics such as the recent Ebola outbreak, there is no vaccine for a deteriorating planet’s effects on a public. But it does mean one thing: a sicker public means more strain on hospitals and healthcare services.

According to the Centers for Disease Control and Prevention, climate change affects air quality (increasing respiratory and cardiovascular diseases), leads to food- and waterborne diseases and causes an uptick in extreme weather events, which injure and kill people in large numbers.

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On the other end, climate change affects a hospital’s functionality and a staff’s ability to deliver health care. So, in response, hospitals are turning to technology and big data to prepare for bigger, future problems.

The Department of Health and Human Services recently published a report to identify best practices and provide guidance on affordable measures to ensure that the medical system is resilient to climate impacts.

According to the report, health care organizations have previously only reacted to climate events as they occurred. Hospitals need to realize that environmental preparedness goes hand-in-hand with geographic resilience, which leads to data-driven climate forecasts dictating infrastructure technologies.

Climate challenges by region

Northeast: Winters result in record-breaking cold temperatures, snow fall and rain

Midwest: Excessive heat waves and flooding

West Coast: Increasing temperatures and droughts

How some hospitals have adapted to change

Opening just four short months ago in February, the University of California San Francisco Medical Center at Mission Bay designed its hospital with climate disaster resilience, resource stability and patient care in mind.

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With California’s drought affecting everything, the medical campus uses an irrigation system that automatically adjusts water output depending on current weather fluctuations. It also has dual-flush toilets and low-flow, high-efficiency showers and basins.

The hospital is expected to save nearly four million gallons of water each year.

The Lucile Packard Children’s Hospital at Stanford University also has a new wing opening in two years and will be placing reusable water into a cistern from three sources: rainwater from the roof, condensate from the air conditioning system and the reject water from dialysis.

These methods give the hospital approximately 110,000 gallons of water at any given time, and if there were ever an emergency and the hospital didn’t want to use its four- to seven-day emergency supply of potable water to flush the toilets, it could drain the cistern water for other uses, reported Pacific Standard.

Mission Bay has figured out how to cut that usage in half by incorporating a standalone central power station, states the magazine. The station works alongside other energy-saving technologies, including heat recovery ventilators that reclaim energy from exhaust overflows, patient rooms with access to natural light, heating and cooling systems that can be controlled remotely in most parts of the facility, and cooling systems that can be controlled remotely in most parts of the facility, and a photovoltaic system that converts solar energy into electricity.

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These methods are saving Mission Bay a reported $784,000 in annual energy bills and reducing its CO2 emissions by 20,000 metric tons.

The 268-bed Miami Children’s Hospital (MCH) serves seven counties in southern Florida, including populous Miami-Dade County, and is the region’s only specialty hospital for children. Beginning in 2001, MCH underwent a state-of-the-art retrofit to enable it to withstand a Category 4 hurricane. It is now wrapped in a hurricane resistant shell.

The project was completed in the spring of 2004, just prior to Florida’s hurricane season. Young patients and their families did not need to evacuate from the hospital when Hurricanes Frances and Jeanne struck.

In addition, the hospital welcomed over 60 children who lived at home but were evacuated from the Florida Keys—children who depended on ventilators or other electrically-powered medical equipment. During Hurricane Frances, MCH was the temporary refuge for nearly 1,000 staff members and their families.

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According to Kevin Hammeran, senior vice president and chief operating officer during the period, “The strengthened building has enhanced the hospital administration’s ability to recruit staff to serve during hurricanes. Many employees feel safer at the hospital during a storm than in their own homes. We also have eliminated barriers by providing on-campus shelter for family members of storm-duty staff. Knowing their spouses and children are within the safe confines of the hospital gives peace of mind to those working through the storm.”

In 2005, the hospital hosted medical evacuees and families who were displaced by Hurricanes Katrina and Wilma.

Looking ahead

Given the current state of health care infrastructure resilience, how are future extreme weather events likely to affect health care delivery in the U.S.?

Most health care organizations have disaster mitigation or emergency operation plans, but not all of them provide organizational alternatives when the normal daily movement of staff, patients, equipment, and supplies are compromised. The critical nature and interdependence of these processes represent a separate category of vulnerabilities that need careful attention, states the report.

To withstand whatever the future holds, it’s time to fundamentally re-think how hospitals operate. Health care systems in the U.S. are larger and more complex than ever before. More societal resources are needed to buffer the impact from these climate events. Part of that is making people healthier by focusing on preventative health care—because healthier people are more resilient to climate impact than unhealthy people—and the rest is using sustainable technologies to embed fortitude into hospital infrastructure and day-to-day operations.

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Jun 13, 2021

How healthcare can safeguard itself against cyberthreats

Jonathan Miles
6 min
Jonathan Miles, Head of Strategic Intelligence and Security Research at Mimecast, tells us how the healthcare sector can protect itself from attacks

One of the most fundamental lessons from the COVID crisis is that health should always be a priority.  In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.

The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics. 

From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world. 

Going digital 

The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years. 

This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate. 

Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.

To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care. 

Strengthening defences

Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change. 

It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device. 

These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.

Despite this, there are fundamentals that any organisation should implement: 
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.

In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.

Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents. 

Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.

This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents. 
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.

Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.

As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.  

Fighting future threats

With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.

To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced. 

This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.

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