Sharing Knowledge: Empowering the NHS
Written by: Nick Miles, Technical Services Director at Imprivata
The NHS has been targeted with a gigantic £20 billion of efficiency savings by 2014-15 - a feat which Health Secretary, Andrew Lansley, has agreed will be an “enormous challenge.” With purse strings so tight, investing in the new technology can be a hard call for any CIO to make, yet for efficiency savings to be realised and quality of the care improved, change is needed. Equally important is the understanding that any new technology initiative requires physician buy-in to be successful. With that in mind, NHS organisations have become increasingly focused on what has and have not worked at other Trusts, and what can be learned from those successes and failures.
Following the dissolution of the National Programme for IT, NHS organisations regained the sovereignty over their choice of IT systems. While benefitting from the autonomy that this provided, trusts remain acutely aware that learning from peers can help to ensure the best IT decisions are made, and that proven practices are repeated - while the same mistakes are not. Interestingly, NHS organisations in England, Scotland and Northern Ireland seem to be approaching this challenge in many different ways.
NHS Scotland has worked closely with the Scottish Government to align with the strategic priorities set out by the “Better Health, Better Care” initiative and the NHS Scotland Information Assurance Strategy. This initiative was established by the Scottish Government to remove the unnecessary costs and delay while better managing the workflow complexity associated with accessing electronic patient data. Building the best security was also a key priority to help protect the increasing volumes of sensitive information while allowing for maximum clinician-patient service improvement. As such, Imprivata OneSign has been deployed nationwide to simplify this process while simultaneously protecting sensitive data.
After a successful pilot site at NHS Fife, which was then used as a blueprint for subsequent rollouts in Scotland, the team at Scotland worked with Imprivata to implement a national information sharing scheme. This enabled all the NHS Boards to access data such as best practice guides, deployment plans, guidelines and schedules, as well as stakeholder contact details. In addition, a quarterly project update meeting has allowed the representatives to meet and discuss challenges and successes. The result of this centralised approach means that project managers completely understand and can take advantage of the services available to them, while also has a sound knowledge of the business and technical elements of the solutions.
English NHS Trusts typically take a different approach to IT procurement and implementation, tending to independently implement solutions. Despite this autonomy, English Trusts completely appreciate the criticality of knowledge sharing and usually seek insight from the neighbouring organisations before making investment and deployment decisions.
Norfolk & Norwich University Hospitals NHS Foundation Trust (Norfolk & Norwich) is a good example. Before beginning work with Imprivata, Norfolk & Norwich spoke with other Trusts which had already begun or completed OneSign deployments. This information sharing meant that the project manager at Norfolk & Norwich gained a better understanding of how the solution works in practice and its benefits to workflow and data security. He also better understood how to ensure fast and seamless end-user adoption, which is critical to the success of any IT project.
Once the decision was made to implement secure No Click Access™ to their patient data, Norfolk & Norwich worked closely with Imprivata to follow the best practice deployment guidelines including tips on integration with Connecting for Health (CfH) National smart card and Spine applications, and best ways to integrate into environments like accident and emergency which require fast-user switching on shared machines.
Most recently, Trusts in Northern Ireland have begun to take a hybrid mix of the Scottish and English approaches.Northern Ireland is served by five NHS Trusts, one of which – South Eastern Health and Social Care Trust – has worked with Imprivata OneSign since 2010.After seeing Scotland’s successful procurement and rollout process, Northern Ireland wanted to take advantage of the same economies of scale and as such have increased the total number of user licences by over 600% to serve two additional trusts. Like NHS Scotland, the Trusts in Northern Ireland are also implementing a set of data knowledge and sharing tools including best practice guides and deployment plans. Working this way has proven to be economical and also means that the Trusts can easily share tips and guidelines for ongoing use – a huge benefit for both staff and patients.
Any lessons pertaining to education, tips and deployment which can be collected and shared, whether that be with neighbouring Trusts, or more widely across a national system, can have a huge impact on a project’s outcome. Looking ahead, sharing best practices will help NHS organisations to not only hit budget targets through efficiency savings, but also to form business cases for new projects, allowing the healthcare industry in the UK to move forward with IT innovation, delivering value and helping to improve the quality of service to patients.
About Mr. Nick Miles, Technical Services Director at Imprivata:
Nick Miles is Technical Services Director at Imprivata, overseeing the Technical Services team across multiple regions worldwide. His area of focus is around the security and workflow management within the healthcare industry, and he specialises in Virtual Desktop Infrastructure and user access workflows. Nick joined Imprivata in February 2009. Prior to joining Imprivata, Nick held a number of senior technical roles plus over 13 years as a communications specialist within the Royal Navy.Imprivata provides secure access and collaboration solutions for the healthcare market, streamlining application access and simplifying working environments to enhance the clinician workflows and increase security.
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.