NRC Health Recovering from Ransomware Attack

NRC Health, a provider of patient survey services and software to more than 9,000 healthcare organizations, including 75% of the largest hospital systems in the United States and Canada, experienced a ransomware attack on February 11, 2020 that affected some of its computer systems.

NRC Health immediately took steps to limit the harm caused and shut down its entire environment, including its client-facing portals. A leading computer forensic investigation firm was engaged to determine the nature and extent of the attack and the incident has been reported to the Federal Bureau of Investigation.

According to the NRC Health website, the data of more than 25 million healthcare consumers in the United States and Canada is collected by NRC Health every year. Patient surveys conducted by NRC Health on behalf of its clients allow them to prove that patients are satisfied with the services they have received. That information is important for helping to improve patient care and also for determining how much Medicare reimbursement healthcare providers receive under the Affordable Care Act. Healthcare clients also used patient satisfaction scores to determine how much executives and physicians get paid.

NRC Health said significant progress has been made restoring its systems and services to customers and a full recovery is expected in the next few days. Notifications have been sent to its healthcare clients informing them about the attack and updates are being provided to clients on a daily basis until the incident is fully resolved.

In the notifications NRC Health said the initial findings of the investigation suggest no patient data or sensitive client information has been compromised.

The emerging digital landscape of the 2020s

Health and care are going through a very accelerated phase of change. There are various drivers causing these changes and these are starting to demonstrably exert their influence as well as start to act synergistically. Among these changes:

Aging and accompanying multimorbidity, both of which drive increases in activity in existing health and care systems as they strive to manage noncommunicable diseases. This increase in activity puts further financial pressures on these systems which are already “over- trading” and further encourages the adoption of value-based solutions where prevention of disease becomes at least as important as treatment of existing conditions. The explosion of availability of data and the deployment of processes that allow for interoperability. This drives the potential to develop more customized treatment plans for people. This availability of data is likely to be further enhanced once 5G networks are employed and the internet of things enabled. The availability of genomic information around individuals which is becoming more commonplace and enables people to better assess their likelihood of developing disease and thus better target their efforts towards risk mitigation in situations where we understand the pathophysiology of disease and the behaviors we need to adopt to lessen the likelihood of developing these. The potential for us to be able to measure the epigenetic biomarkers that act as “switches” amplifying or turning off the effect of our genes and the increasing affordability of access to these biomarkers. At present these are mainly concentrated around the cardiovascular space, but no doubt the range will widen as science advances. Also the fact that the cardiovascular contribution to cardio-metabolic disorders is now understood to have an even more ubiquitous role is an added factor to take into consideration

Nurses: Dealing With Suicide and Burnout

Suicide Risk Among Nurses Researchers at University of California San Diego School of Medicine and UC San Diego Health, Department of Nursing, have conducted a national longitudinal study and found that the rate of suicide among nurses is higher than that of the general population (Davidson et al. 2020a).

An analysis of data from the 2005–2016 National Violent Death Reporting System dataset showed that female nurses have been at greater risk since 2005 and males since 2011. Lead author Judy Davidson notes that “the data does not reflect a rise in suicide, but rather that nurse suicide has been unaddressed for years.”

Over the analysed period, female nurse suicide rates were significantly higher than the general female population, 10 vs 7 per 100,000 respectively. For male nurses and the general male population the figures are 33 vs 27 per 100,000 respectively.

The preferred methods of suicide among females were opioids and benzodiazepines, while firearms was the most common choice for male nurses.

The authors point out the necessity to implement suicide prevention programmes. One such programme, successfully tested by UC San Diego, is Healer Education Assessment and Referral (HEAR) programme. It provides education about risk factors and proactive screening focussed on identifying, supporting and referring clinicians for untreated depression and/or suicide risk. The sustainability of HEAR is explored in another study by Davidson and colleagues (2020b) claiming that it proved to be feasible and well‐received and proactively identifies nurses with reported suicidality and facilitates referral for care.