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The Petya Global Malware Incident Hitting Nuance, Merck, and Many Others

Posted on July 3, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Petya Malware (or NotPetya or ExPetya) has really hit healthcare in a big way. The biggest impact on the healthcare IT world was the damage it caused to Nuance, but it also hit Merck and some other healthcare systems. After a shaky start to their communication strategy, Nuance seems to finally at least be updating their customers who saw a lot of downtime from when it first started on June 28 until now. This rogue Nuance employee account has been pretty interesting to watch as well. There’s a lesson there about corporate social media policies during a crisis.

Petya was originally classified as ransomware, but experts are now suggesting that it’s not ransomware since it has no way to recover from the damage it’s doing. It’s amazing to think how pernicious a piece of malware is that just destroys whatever it can access. That’s pretty scary as a CIO and it’s no surprise that Petya, WannaCry, and other malware/ransomware is making CIOs “cry.”

It’s been eye opening to see how many healthcare organizations have depended on Nuance’s services and quite frankly the vast number of services they offer healthcare. It’s been extremely damaging for many healthcare organizations and has them rethinking their cloud strategy and even leaving Nuance for competitors like MModal. I’m surprised MModal’s social team hasn’t at least tweeted something about their services still being available online and not affected by Petya.

I’ll be interested to see how this impacts Nuance’s business. Nuance is giving away free versions of their Dragon Medical voice recognition software to customers who can’t use Nuance’s transcription business. Long term I wonder if this will actually help Nuance convert more customers from transcription to voice recognition. In the past 5 days, Nuance’s stock price has droppped $1.54 per share. Considering the lack of effective alternatives and the near monopoly they have in many areas, I’ll be surprised if their business is severely damaged.

As I do with most ransomware and malware incidents, I try not to be too harsh on those experiencing these incidents. The reality is that it can and will happen to all of us. It’s just a question of when and how hard we’ll be hit. It’s the new reality of this hyper connected world. Adding to the intrigue of Petya is that it seems to have been targeted mostly at the Ukraine and companies like Nuance and Merck were just collateral damage. Yet, what damage it’s done.

Earlier today David Chou offered some suggestions on how to prevent ransomware attacks that are worth considering at every organization. The one that stands out most to me with these most recent attacks is proper backups. Here is my simple 3 keys to effective backups:

Layers – Given all the various forms of ransomware, malware, natural disasters, etc, it’s important that you incorporate layers of backups. A real time backup of your systems is great until it replicates the malware in real time to your backup server. Then you’re up a creek without a paddle. An off site backup is great until your off site location has an issue. You need to have layers of backup that take into account all of the ways your data could go bad, be compromised, etc.

Simple – This may seem like a contradiction to the first point, but it’s not. You can have layers of backups and still keep the approach simple and straightforward. Far too often I see organizations with complex backup schemes which are impossible to monitor and therefore stop working effectively. The KISS principle is a good one with backups. If you make it too complex then you’ll never realize that it’s actually failing on you. There’s nothing worse than a failed backup when you think it’s running fine.

Test – If you’ve never tested your backups by actually restoring them, then you’re playing russian roulette with your data. It’s well known that many backups complete without actually backing up the data properly. The only way to know if your backup really worked is to do a test restore of the data. Make sure you have regularly scheduled tests that actually restore your data to a backup server. Otherwise, don’t be surprised if and when your backup doesn’t restore properly when it’s really needed. Malware events are stressful enough. Knowing you have a good backup that can be restored can soften the blow.

Backups won’t solve all of your problems related to malware, but it’s one extremely important step in the process and a great place to start. Now I’m going to go and run some backups on my own systems and test the restore.

Where is Voice Recognition in EHR Headed?

Posted on August 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve long been interested in voice recognition together with EHR software. In many ways it just makes sense to use voice recognition in healthcare. There was so much dictation in healthcare, that you’d think that the move to voice recognition would be the obvious move. The reality however has been quite different. There are those who love voice recognition and those who’ve hated it.

One of the major problems with voice recognition is how you integrate the popular EHR template documentation methods with voice. Sure, almost every EHR vendor can do free text boxes as well, but in order to get all the granular data it’s meant that doctors have done a mix of clicking a lot of boxes together with some voice recognition.

A few years ago, I started to see how EHR voice recognition could be different when I saw the Dragon Medical Enabled Chart Talk EHR. It was literally a night and day difference between dragon on other EHR software and the dragon embedded into Chart Talk. You could see so much more potential for voice documentation when it was deeply embedded into the EHR software.

Needless to say, I was intrigued when I was approached by the people at NoteSwift. They’d taken a number of EHR software: Allscripts Pro, Allscripts TouchWorks, Amazing Charts, and Aprima and deeply integrated voice into the EHR documentation experience. From my perspective, it was providing Chart Talk EHR like voice capabilities in a wide variety of EHR vendors.

To see what I mean, check out this demo video of NoteSwift integrated with Allscripts Pro:

You can see a similar voice recognition demo with Amazing Charts if you prefer. No doubt, one of the biggest complaints with EHR software is the number of clicks that are required. I’ve argued a number of times that number of clicks is not the issue people make it out to be. Or at least that the number of clicks can be offset with proper training and an EHR that provides quick and consistent responses to clicks (see my piano analogy and Not All EHR Clicks Are Evil posts). However, I’m still interested in ways to improve the efficiency of a doctor and voice recognition is one possibility.

I talked with a number of NoteSwift customers about their experience with the product. First, I was intrigued that the EHR vendors themselves are telling their customers about NoteSwift. That’s a pretty rare thing. When looking at adoption of NoteSwift by these practices, it seemed that doctor’s perceptions of voice recognition are carrying over to NoteSwift. I’ll be interested to see how this changes over time. Will the voice recognition doctors using NoteSwift start going home early with their charts done while the other doctors are still clicking away? Once that happens enough times, you can be sure the other doctors will take note.

One of the NoteSwift customers I talked to did note the following, “It does require them to take the time up front to set it up correctly and my guess is that this is the number one reason that some do not use NoteSwift.” I asked this same question of NoteSwift and they pointed to the Dragon training that’s long been required for voice recognition to be effective (although, Dragon has come a long way in this regard as well). While I think NoteSwift still has some learning curve, I think it’s likely easier to learn than Dragon because of how deeply integrated it is into the EHR software’s terminology.

I didn’t dig into the details of this, but NoteSwift suggested that it was less likely to break during an EHR upgrade as well. Master Dragon users will find this intriguing since they’ve likely had a macro break after their EHR gets upgraded.

I’ll be interested to watch this space evolve. I won’t be surprised if Nuance buys up NoteSwift once they’ve integrated with enough EHR vendors. Then, the tight NoteSwift voice integrations would come native with Dragon Medical. Seems like a good win win all around.

Looking into the future, I’ll be watching to see how new doctors approach documentation. Most of them can touch type and are use to clicking a lot. Will those new “digital native” doctors be interested in learning voice? Then again, many of them are using Siri and other voice recognition on their phone as well. So, you could make the case that they’re ready for voice enabled technologies.

My gut tells me that the majority of EHR users will still not opt for a voice enabled solution. Some just don’t feel comfortable with the technology at all. However, with advances like what NoteSwift is doing, it may open voice to a new set of users along with those who miss the days of dictation.