BIOMEDICAL: System protects medical devices from cyber-attack
DESIGN: New version of LEED pushes building performance
ENGINEERING: Hospital partners with utility to cut energy, water use
OPERATIONS: Mobile ASHE app provides on-the-go resources
If you're still waiting to protect your health care facility's medical devices from a cyber-attack, let a close call at Methodist Hospital of Southern California, Arcadia, serve as a cautionary tale.
In 2011, hospital physicians accessed diagnostic information from medical devices without the knowledge of the facility's information technology (IT) department. Once hospital administrators caught wind of what happened, they took action to safeguard its medical devices because they knew the next incident involving the access of patient data might not be so benign.
The hospital was smart to act quickly. As medical devices have increased in complexity and are commonly tied to computer networks, they pose a higher risk for cyber-attack.
In June, the Food and Drug Administration issued a safety communication alerting medical device manufacturers and health care facilities to ensure that appropriate safeguards are in place to reduce the risk of failure due to cyber-attack either through malware or unauthorized access to devices and networks.
In May, the Department of Homeland Security issued a bulletin warning that too little consideration has been given to the potential for misuse of features like wireless networking connectivity to steal patient information or even change the operation of the medical device.
The bulletin reported how medical device hackers could alter or shut off the settings of an insulin pump without the user's knowledge and jam or disrupt glucose monitors remotely. Implantable medical devices without software protection are at risk, too, the bulletin stated.
Implementing appropriate safeguards is exactly what Methodist Hospital began doing two years ago. It hired an outside firm to develop an integrated systems management (ISM) program, which greatly reduces vulnerability of its more than 6,000 medical devices to cyber-attack.
The ISM program was developed by Renovo Solutions LLC, Santa Ana, Calif., and managed by Anthony Coronado, biomedical engineering manager at Methodist Hospital, and his team. The program is so innovative that last month the hospital received ECRI Institute's 8th annual Health Devices Achievement Award.
"Methodist Hospital conducted a great project to address a looming and national concern related to cyber-security and medical devices," says Jim Keller, vice president, health technology evaluation and safety, ECRI Institute, Plymouth Meeting, Pa.
"Not many hospitals have put a concerted effort toward addressing the risks of cybersecurity of medical devices. The Methodist program sets a great example that other hospitals can follow and in a very organized and methodical way," Keller says.
A cornerstone of the program entails performing a rigorous 57-question, risk-assessment inspection of each new and existing medical device at the hospital to determine how it stores, transmits and protects electronic patient information, Coronado says.
Part of the risk-assessment involves interviewing the end user, whether it is a physician, nurse or other staff member, to see how he or she uses the device, he adds.
Another problem was that almost all the medical devices at Methodist Hospital were on their own networks and not monitored for security, a common situation at many health care facilities, Coronado says. "I feel it's probably the same way at the majority of hospitals around the world," he says.
Integrating the multitude of networks at Methodist made it easier to control and monitor its medical devices by taking advantage of the safeguards that were already in place within the hospital's IT infrastructure for all the PCs and medical record networks, he adds.
Keller believes Methodist Hospital's ISM program could serve as a model for all hospitals as the need to protect devices against hackers grows.
"With the rapid growth of connectivity for medical devices, this is a serious problem," he says. "This is why the Methodist project is so important. It will help many hospitals get moving on their cybersecurity initiatives before serious damage is done."
By Jeff Ferenc, senior editor.
The need to elevate and monitor overall building performance, especially water and energy usage, are major priorities with Leadership in Energy & Environmental Design version 4 (LEED v4), which was launched by the U.S. Green Building Council (USGBC) at its annual conference and expo last month as the latest installment of the building certification program.
"LEED v4 is poised to raise the bar on performance and has the potential to reduce CO2 emissions more than any other versions of the LEED rating systems," USGBC officials say.
Among key objectives, LEED v4:
• Places a renewed importance on integrative processes and the benefits of early design analyses and project team collaboration.
• Requires building level water and energy metering to understand and manage performance.
• Increases emphasis on energy and the associated impacts by allocating about 20 percent of all points to energy-efficiency.
• Encourages enhanced building commissioning for greater energy and operational performance.
• Supports a life-cycle approach to product and material specification through a revised and strengthened materials and resources credit category. This provides an incentive to building product manufacturers to provide full transparency on what's used in materials and their life-cycle impacts.
At least one major architectural firm with a track record of designing sustainable health care facilities says it welcomes any challenges LEED v4 brings to hospital design.
"At Perkins+Will, we applaud the USGBC for the latest version of LEED v4 as it continues to raise the bar of performance around key issues such as resource consumption and material health," says Breeze Glazer, LEED AP BD+C, associate, research knowledge manager.
"I anticipate this to continue as our sector moves from buildings that do less harm, to no harm, to eventually ones that can heal," he says. "LEED is a vital tool in this effort and v4 will further drive the innovation needed to make these long-terms goals our reality."
Responding to comments that some of the requirements in LEED v4 may be too demanding, Glazer says that's good because the certification program needs to drive progress.
"I think it is important for the goals not to be entirely realistic today, or otherwise it doesn't function as a tool for change," he says. "The entire idea of LEED is to drive innovation and change, so what may be difficult to do on a project today becomes that much easier tomorrow.
Glazer says Perkins+Will is already designing carbon- and water-neutral hospitals today. "It may not be easy, but certainly is possible," he says.
Even so, USGBC is taking a phased approach to LEED v4. Rather than requiring all new projects to be built to LEED v4 guidelines right away, USGBC is giving the marketplace time to become familiar with the concepts and theories on which it is based. Project teams can register their projects under LEED 2009 until June 1, 2015.
For more information on LEED v4, go to www.usgbc.org/resources/leed-v4-user-guide and click the download button.
Nyack (N.Y.) Hospital will invest an estimated $1 million in energy- and water-saving upgrades without spending a dime in up-front costs, thanks to a conservation program offered by Constellation, its local electric utility.
In return for signing a four-year electricity contract with Constellation through its Efficiency Made Easy program, Nyack will reap the benefits of a range of energy- and water-saving measures paid for by the utility.
The hospital expects to save about $270,000 per year by reducing electricity use by more 1.24 million kWh annually. Energy upgrades will eliminate 1.6 million pounds of carbon dioxide emissions each year.
The hospital also expects to reduce water usage by 10 million gallons annually through a series of conservation measures, says Jared Shapiro, director of ancillary services, construction and safety.
"Environmental stewardship is one of the ways in which we carry out our mission and responsibility to care for the community," says John Volanto, vice president and chief information officer.
Key conservation measures Nyack will take include installing energy-efficient lighting and controls, low-flow faucets and shower heads, water leak repairs, steam plant upgrades and sterilizer condensate tempering.
The cost of the efficiency measures paid for by Constellation is included in the price per kWh over the term of Nyack's electricity supply agreement with Constellation.
Some conservation work has started and the remainder is scheduled for completion during the first quarter of 2014, says Thomas Tufaro, plant and facilities manager.
Gary Fromer, senior vice president, energy management programs at Constellation, says the utility's conservation program makes it easier for customers like Nyack to overcome financial hurdles caused by capital investment costs.
Nyack is a 375-bed acute care medical-surgical hospital in Rockland County, N.Y.
A new mobile application from the American Society for Healthcare Engineering (ASHE) will bring facility professionals regulatory updates, news, educational opportunities and more to their Apple and Android devices.
The Mobile ASHE app, available free through the iTunes store or Google Play, will deliver the following types of information to users:
• News. The ASHE news feed covers regulatory updates, news stories and press releases.
• Acronyms. The app allows users to browse or search to find meanings of hundreds of health care, business and military acronyms.
• Monographs. Members can access ASHE monographs through the app, which cover single topics on such issues as engineering, design, construction, and safety and security.
• Calendar. This provides a listing of ASHE events, including workshops and educational opportunities.
• Social media. This section of the app connects with ASHE's social media channels, including LinkedIn, Twitter, YouTube and the ASHE blog.
"Our team has worked to streamline the development of news and resources for ASHE members. The ASHE news feed allows for the mobile app to be updated instantaneously. As such, the mobile app will be updated regularly with new articles, resources and other pertinent information," says Patrick Andrus, ASHE's director of business development.
Andrus adds that app users also will bring ASHE members closer together.
"One of the valuable benefits of being an ASHE member is the ability to share ideas, best practices, etc., with other ASHE members. ASHE's social media outlets provide another platform, in addition to our Listserv and blog, for members to engage with one another.
ASHE uses these platforms to share news and information, as well as gain insights from members on emerging issues," Andrus says, adding that the organization will continue to add features to the app.
The Joint Commission recently published a roundup of several new frequently asked questions posted to its website.The roundup, which appeared in the Oct. 30 issue of the Joint Commission Online e-newsletter, features standards questions about emergency cart security, laundering of surgical scrubs and other attire, and use of self-contained, high-level disinfection units for semicritical devices.
For more, go to www.jointcommission.org/assets/1/23/jconline_October_30_13.pdf
Clinical alarm hazards topped the 2014 Top 10 Health Technology Hazards list in a recent report by ECRI Institute, Plymouth Meeting, Pa.The 16-page brief also covers such hazards as infusion pump medication errors; computed tomography radiation exposure in pediatric patients; data integrity failures in electronic health records and other systems; occupational radiation hazards in hybrid operating rooms; inadequate reprocessing of endoscopes and surgical instruments; neglecting change management for networked devices and systems; risks to pediatric patients from "adult" technologies; robotic surgery complications; and retained devices and unretrieved fragments.
For more, go to www.ecri.org/2014hazards
The Centers for Medicare & Medicaid Services (CMS) now require nursing homes to be fully sprinklered to participate in Medicare and Medicaid, according to a report in the American Society for Healthcare Engineering's ASHE Insider e-newsletter.
Nursing homes originally were required to be fully sprinklered by August 2013, and CMS suggested a proposed rule in February that would have allowed extensions under certain circumstances. However, the rule was never finalized, so the August deadline went into effect.
CMS stated in an August memo about the issue that nursing homes that are not fully sprinklered face citations, ASHE reports.
For more, go to http://go.cms.gov/1dz0Kl3
Health & Human Services (HHS) recently awarded $5 million for research to support long-term recovery from last year's Hurricane Sandy, and another $3.6 million will be available to support additional research and resources.
"We anticipate that the findings not only will help community leaders make evidence-based decisions about recovery plans and policies … but also that the knowledge gained can improve resilience across the entire country," says Nicole Lurie, M.D., HHS assistant secretary for preparedness and response.Also, the research will assess how to strengthen health system preparedness.
For more, go to www.hhs.gov/news/press/2013pres/10/20131022a.html
UC Health recently broke ground for a new outpatient medical office building in Florence, Ky.
The two-story, 42,000-square-foot facility, which is expected to be completed in July 2014, is being designed and constructed by Al. Neyer LLC.
It will serve as one of eight UC Health primary care centers opening or relocating in 2014–2015 and will include specialty practices.
UC Health already has orthopedics and dermatology practices in Northern Kentucky. Those practices will remain open in their current locations during construction of the new location, but will move to the new facility upon its completion in July.
The new facility will also allow UC Health to add services in Northern Kentucky. The office will serve as another one of UC Health's primary care centers, and will also include specialty practices in cardiology, endocrinology, neurology, and obstetrics and gynecology.
Peter Iacobell, vice president of strategic planning/development for University of Cincinnati Physicians and UC Health, says the expansion in Florence is part of UC Health's comprehensive strategy to grow where there is an increasing need for access to quality health care.
"Access is a top system priority, so our expansion plan focuses on enhancing access to quality health care — both in terms of geography and specialty care — for patients throughout the Tristate," Iacobell says.
Groundbreaking recently was held for a new 24,000-square-foot QueensCare Health Centers facility in East Los Angeles, Calif.
Consolidated Contracting Services Inc. is building the two-story facility, which will encompass 38 medical exam rooms, nine dental operatories for adult and pediatric dentistry, three counseling rooms and two meeting rooms.
It will also contain a 1,000-square-foot conference room that will serve as a venue for hosting health events and community meetings.
RBB Architects, Inc., Los Angeles, is the project architect; KPFF Consulting Engineers, Los Angeles, is the civil engineer; N A Cohen Group, Encino, is the electrical engineer; and Applied Earth Sciences, Los Angeles, is the environmental engineer. Carter Romanek Landscape Architects, Los Angeles, is the landscape architect.Construction is slated for completion in August 2014, and the health center will be open to serve patients in early 2015.
Construction is set to begin soon on the new 155,000-square-foot, 69-bed Riverside Shore Memorial Hospital, Nassawadox, Va., along with an adjacent 40,000-square-foot medical office building.
All 69 patient rooms in the new hospital will be private with the capability to add 12 more. Other features will include inpatient and same day surgery, three operating rooms, a 24-hour emergency department, a diagnostic center with fixed magnetic resonance imaging and outpatient services.
The medical office building will house a cancer center, physician offices and support services.
Skanska USA has been awarded a $33 million contract for the construction of a new facility at the Duke Eye Center, Durham, N.C.
Construction is already underway for the 125,700 square-foot building which will offer a patient and family-centered approach to care and includes parking and a covered entrance with prominent presence.
The design incorporates Duke's new electronic medical record system into the workflow and as well as new amenities and services designed to greatly enhance and streamline the patient experience.
Once completed, the new facility will be part of the Duke Eye Center, which includes the Albert Eye Research Institute and the Wadsworth Building.
This will further advance Duke Medicine's mission of better serving the rapidly growing region with cutting edge research integrated with the best in clinical care.
The project is slated for completion in fall 2015.