Ministry of Health (Israel)
As chronic diseases evolve and take centre stage, patients live longer, and unhealthy lifestyles become a greater threat, healthcare systems have to change. Israel, like much of the world, has had to transform its own systems in order to keep up with changes, putting pressure on the nation’s Ministry of Health.
Shira Lev-Ami, the Ministry of Health’s Chief Information Officer, has spent her five years with the organisation faced with the challenge of altering both the mindset of colleagues and the processes by which the Ministry operates. Lev-Ami’s multi-disciplinary background which includes earning three masters degrees (political science, law, and business administration) led to jobs in many different corporate sectors, before she decided on a meaningful career in the public health sector.
“I started working for non-profit organisations, learning how to create philanthropic strategies,” she explains. “I wanted to create infrastructure that otherwise would not exist. It was always my hobby to think ‘how can this process be improved?’ Eventually I applied for a job with the government where I could make a difference.”
The Ministry of Health’s outdated information systems proved an uphill battle to change for Lev-Ami. Israel’s Ministry of Health involves around 100 business units, each with different processes and information systems. When Lev-Ami joined the Ministry, almost all of those units came to her, demanding their work processes be supported by adequate information systems.
"It's hard to believe that in the year 2016, we still have core processes managed manually. For example, the Ministry's inspectors – monitoring restaurants, schools, swimming pools, and so on for sanitation quality – use a pencil and notebook for their work." While she was up to the challenge, managing 300 different projects needing to be planned and implemented simultaneously was daunting.
“The necessity for revolutionising IT was clear, but moving forward quickly in a government setting is sometimes viewed as an oxymoron: government processes require long tenders and overcoming many bureaucratic obstacles. It can be very discouraging, and explains why a lot of younger and more technologically-minded people don’t necessarily want to work for the government. You need a lot of optimism and to believe that there’s always a way.”
The challenge for Lev-Ami’s team is providing the best possible service to all of these units, through creating common technological platforms as the means for synergy: “If you do a good job planning ahead and building enterprise-wide solutions, re-using the common features for any additional required process becomes easy. It’s like a city architecture: design a new city well, and traffic will flow seamlessly; trying to expand a road that was built for carriages in the 18th century will prove much more difficult.
“We’re now in a better situation, but we still have a lot of work ahead of us just to make sure we’re supplying the basics.”
The Israeli Ministry of Health, as part of the National ‘Digital Israel’ initiative, aspires to promote the Israeli healthcare system through the use of digital technologies. "We had to make a significant leap in the way we supply health services,” she says. “There’s a saying: trying to provide medical services in the 21st century using 20th century methods would require an impossible amount of doctors. The transformational part of what we’re doing is looking at the Health system and the technologies to move it forward.
“As a Ministry leading the transformation, we have an array of tools to utilise. We combine the use of regulatory guidance with government incentives, designed to stimulate investment in digital health arenas which are under-utilised. In other areas, we’re creating technological infrastructures ourselves, paving the highways for digital health applications and innovation.”
One of Lev-Ami’s biggest recent projects has been reinventing the national health information exchange network, which she has put into place over the past few years. It is where all public healthcare organisations - providers and hospitals - are able to connect to one network which carries personal medical records. While it is simpler to build one database and fill it with information for all to view, for privacy reasons, it had to be designed in a way that had no central repository.
“People get medical treatment in very many places, and the challenge lies in how we make sure all of these treatments are connected, and that crucial medical information can’t fall between the cracks. We took responsibility for providing the infrastructure, not just the regulation, and succeeded in tackling the continuity of care challenge. The next step is utilising the national health information exchange in a way that enables system-wide innovation.”
Another nationwide project has been focussed on the emergency departments. Over a quarter of Israel's population visits an ER at least once a year, as a patient or chaperone, many leaving with a bad experience. Targeting shortening waiting periods in the ER, Lev-Ami's team is deploying a sophisticated system to improve the process. Optimising the ER workflow, while providing patients with information on their precise location in the medical process and estimated wait times, has proved vital in improving patient experience:
"We're developing an ER app which we view as a medical version of Waze, providing transparency on real-time ER situation for patients and decision-makers alike".
The healthcare sector is built around the concept of ‘do no harm’, which unfortunately goes hand-in-hand with ‘make no change’. However, Lev-Ami and her team have managed to turn the Ministry of Health’s IT system on its head, which has had the added benefit of vastly increasing trust in the Ministry's leading role among Healthcare teams, as a valued partner.
“The Ministry of Health is a crucial organ for Israeli society, focussing on providing quality and equal healthcare,” Lev-Ami concludes. “To make a process move forward you have to be both a visionary, and very proactive. In the end, the staff working for the Ministry of Health are people who want to do good. People here work from the heart.”
How healthcare can safeguard itself against cyberthreats
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.
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.
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.