Experts say hospitals must plan for providing care after an attack

Cybersecurity and patient safety

Experts offer advice for hospitals on protecting systems and patients

Tips and tough love

Criminals know smaller systems are vulnerable to cyberattacks

Targeting small hospitals

A woman is in prison after fatally shooting her husband in a hospital in Daytona Beach, Florida, and some questions remain about the incident.

It remains unclear how she managed to get a firearm in the hospital, and police said she declined to answer questions from investigators.

Police say Ellen Gilland, 76, shot and killed her terminally ill husband, who was being treated at AdventHealth Daytona Beach Hospital. The woman initially intended to take her own life after shooting her husband, Jerry Gilland, 77, but she couldn’t go through with it, Daytona Beach Police Chief Jakari E. Young said, according to a 

Authorities said nobody else was injured in the incident, which took place Jan. 21. She remained in the room for hours after shooting her husband, police said.

Gilland has been charged with murder and aggravated assault, police said. 

Daytona Beach police provided more details on the incident Monday and also released body camera footage, which shows officers shouting at her to drop the gun. One member of the team implores her, "We don't want to hurt you ... Talk to me." Police eventually are seen removing her from the hospital, in a wheelchair. 

(You can watch part of the police video; the story continues below.)

The hospital staff had to evacuate patients, which police described as a “logistical nightmare,” according to reporting by 

. Most of the patients on that floor are on ventilators, police said.

Daytona Beach police released the arrest report Monday, which provided more details on the incident.

Two witnesses entered the hospital room after the shooting, according to the report. Police said Gilland pointed the firearm at the two individuals and ordered them to leave the room, and they did.

Another witness entered the room after hearing the firearm, and recognized the suspect as the victim’s wife. Gilland pointed the weapon at the witness’ chest and told the witness to get out of the room, the witness told police. The witnesses were not identified in the police report.

More than four hours after the shooting, police used a “flashbang” distraction device and a SWAT team entered the room.

The SWAT team used a stun gun, which was unsuccessful in subduing Gilland, police said. As the stun gun was fired at her, Gilland shot a round from her handgun, which struck the ceiling above her husband’s bed, police said. She then dropped the gun and the SWAT team apprehended her without further incident, according to the arrest report.

A detective attempted to interview Gilland but she declined to answer questions and asked for a lawyer, police said.

The incident comes after fatal shootings at medical facilities in 

 last year. Doctors and nurses complained that 

they are encountering more violence from patients and families members in the COVID-19 pandemic

The police chief said, "Obviously, we're unsure how she brought that gun into the hospital, but this was planned,” WESH reported.

In a statement about the incident Monday, Daytona Beach police said, “We worked together as a team and accomplished the best possible outcome given the situation.”

While no staff were injured, hospital employees were told to remain in place, and one doctor told CNN he stayed in a supply closet.

Hospitals need to train staff to deal with threats

, including someone with a weapon, Brine Hamilton, then-president of the 

International Association for Healthcare Security and Safety

“The big thing is training,” Hamilton said, and he added, “Not just security staff but all staff.”

Healthcare systems should consider forming multidisciplinary teams, including members of clinical and security staff, to address workforce violence and assess threats, Hamilton said.

“Generally speaking, security and clinical have a different mindset when approaching these situations,” he said. “It fosters the opportunity for these different stakeholders to approach each other.”

More hospitals have been deploying metal detectors and other technology to screen for weapons, Paul Sarnese, assistant vice president for security at Virtua Health in New Jersey, said during 

an online discussion on improving healthcare security in November

. Sarnese is a former president of the International Association of Healthcare Security and Safety.

Hospitals looking to take such steps have to also deploy or hire security staff.

“It’s the investment in technology, which is getting cheaper every day, and the investment of people power, which a lot of organizations are struggling with,” Sarnese said during the discussion.

Doctors and nurses have been calling on healthcare organizations to do more to protect staff from violent incidents. 

Less than half of nurses surveyed (47%) said they think their employers value their safety and health

, according to a report by the American Association of Critical-Care Nurses.

Sarah Warren, a nurse who has written about the violence healthcare workers face, wrote on Twitter after the Daytona Beach hospital shooting.

“No patient or healthcare worker should have to worry about an individual entering the hospital with a gun on top of the stress of needing medical care or providing it,” she 

Daytona Beach police referred inquiries about the hospital’s security to AdventHealth.

A request for comment from AdventHealth wasn’t returned Monday.

In a statement, AdventHealth said, "We are devastated by the tragedy that unfolded at the AdventHealth Daytona Beach campus today, and our prayers are with those impacted. We are grateful for the Daytona Beach Police Department in helping ensure the safety of our patients, team members and visitors,” WESH-TV reported.

AdventHealth operates 51 hospitals in nine states.

 offers a host of resources for healthcare organizations to reduce workplace violence.

Articles

Authorities say it’s unclear how she was able to bring a gun into the hospital. She remained in the room for hours, forcing patients to be moved.

After woman fatally shoots terminally ill husband in Florida hospital, questions persist

More healthcare organizations say they are being hit with ransomware attacks, and more say they are having an impact on patient care.

 released by the Ponemon Institute. The survey was commissioned by Censinet, a cybersecurity firm. The institute surveyed 579 information technology professionals at healthcare organizations in the fourth quarter of 2022 and the findings were released Nov. 18.

Nearly half (47%) said their organizations experienced a ransomware attack in the past two years, up from 43% in 2021. Hospital leaders have said 

they have been seeing more ransomware attacks in recent months

More IT professionals are saying the attacks led to complications in patient care, with 45% reporting complications from medical procedures due to ransomware attacks, up from 36% in 2021. More than half of those surveyed (53%) say a ransomware attack resulted in a disruption in patient care.

More sophisticated cyberattacks threaten healthcare organizations

About one in five respondents (21%) said ransomware attacks had an adverse attack on mortality rates, a slight drop from 2021 (22%).

Among other patient impacts, more than two-third of IT professionals (70%) said patients had to be transferred or diverted to other facilities, and 68% said the attacks led to patients having longer stays in the hospital.

“Ransomware continues to shut down hospital operations and disrupt care at an alarming rate,” Ed Gaudet, CEO and founder of Censinet, said in a statement accompanying the report.

Cybersecurity in healthcare: Even with progress, many vulnerabilities remain

Healthcare leaders have been increasingly calling for hospitals and health systems to deal with 

cybersecurity as a threat to patient care

, in addition to the financial and reputation costs.

IT professionals say there is a significant rise in ransomware attacks triggered through a third party. Among those reporting they experienced a ransomware attack, 46% said it was triggered by a third party, up from 36% in 2021.

The average ransom payment has increased to $352,541, up from $282,675 two years ago, the report said.

Cybersecurity experts say the cost to healthcare organizations go well beyond ransom payments when factoring in added expenses in manpower and in implementing other protections. 

The average healthcare breach now costs more than $10 million

, according to a July 2022 report from IBM Security.

On the upside, more organizations say they are taking steps to deal with ransomware attacks.

The survey found 60% of respondents said their organizations have business continuity plans in the event of ransomware attack, up from 54% in 2021. And 33% said they have increased funds for a possible ransomware attack, up from 23% in 2021.

Healthcare organizations reported hundreds of cyberattacks and data breaches in 2022, and those incidents affected millions of Americans.

The 11 biggest health data breaches in 2022

The survey made a case for organizations to engage in benchmarking cybersecurity measures with other peer organizations as a useful tool in building stronger protections.

More than three out of four respondents (78%) said benchmarking is useful in demonstrating the effectiveness of cybersecurity programs, while more than half (52%) said benchmarking improves cybersecurity programs.

Read more cybersecurity coverage from Chief Healthcare Executive

Hospitals must do more to improve cybersecurity

How hospitals can improve their cybersecurity

Information technology pros said the attacks are causing more health complications, and many say they’ve had to transfer patients or have seen longer hospital stays.

Ransomware attacks continue to rise, and they're hurting patients: Survey

Christopher McCann says hospitals shouldn’t fixate on the past.

McCann is the CEO of Current Health, a technology company which helps health systems provide healthcare at home, including hospital-at-home programs. The Scottish healthtech leader sees a great deal of promise in offering acute care at home, but he also understands why some healthcare leaders may be tempted to focus on care within the hospital.

“I think hospitals are in a difficult spot right now,” McCann says. “They’ve seen their volumes and their revenue go down, their costs are higher, a lot higher. So I think a lot of leaders are saying, ‘We’re going to focus on what we know best, which is in-patient, heads in beds.’”

“We’re also seeing a lot of hospitals recognize the future is going to be different, and we can’t just invest in what we’ve done in the past,” he continues. “We have to invest in the future.”

And that means looking at offering more care at home, including more acute care, he says.

“The future isn’t just going to be inpatient,” McCann says. “Everyone agrees that part of the future of care is going to be care in the home. So we have to think about that future.”

 during the HLTH Conference in November. He shared his thoughts on the changing healthcare landscape, how he feels Best Buy’s acquisition of Current Health has primed the company for growth, and how healthcare leaders can ensure home-based care can succeed.

There will always be a place for the hospital, but he says some patients can receive excellent care at home.

“For me, it’s how do we deliver, without being cliche, the right care in the right place at the right time for those individual populations,” McCann says. (

See part of our conversation in this video. The story continues below.)

more hospitals have been offering acute care in the home

, because the federal government gave health systems more flexibility in offering acute care at home. Congress and President Biden agreed to 

a two-year extension of those flexibilities in the $1.7 trillion omnibus spending package

Home hospital programs are “one of the most innovative test programs that have come out during the pandemic,” Kyle Zebley, senior vice president of public policy for the American Telemedicine Association, told 

 in December. He called the extension of hospital-at-home waivers “a huge victory.”

To date, 260 hospitals (114 health systems) in 37 states are offering hospital-at-home programs, according to 

With more systems launching or at least exploring such options, McCann says, “We’re really, really positive about our current growth trajectory.”

Current Health is working with more than 20 health systems.

“We work with many of the nation's leading health systems, people like Geisinger, UMass, NYU, Mount Sinai,” McCann says. “We work all across the United States, supporting hospital-at-home, all the way down to chronic disease management. We are trying to be one single solution, regardless of whether it’s an acute patient in hospital at home, or whether it’s a chronic disease management patient.”

Best Buy’s purchase of the company bodes well for its long-term prospects, he says. The retailer known for computers and electronics moved into the healthcare space when 

it acquired Current Health in a $400 million deal in 2021

With the acquisition, Current Health’s technology is coupled with Best Buy’s strengths in logistics and supply chain management. Health systems “are excited about those capabilities,” McCann says.

Best Buy brought in experienced healthcare leaders, he adds. Deborah DiSanzo, president of Best Buy Health, has been in healthcare for 30 years, he notes. Best Buy built “a proper healthcare team,” McCann says.

“I think they came into it with a very thoughtful and in my opinion, a mature and intelligent perspective,” McCann says. “They knew that they needed a company like ours, and went out and looked in the market, and thankfully thought we were the best. It was timed very well for us. We thought that being successful in this space required some of the things Best Buy had. So it came together really nicely.”

While many healthcare leaders see more treatment being shifted to the home, McCann sees the future as a hybrid of home-based care and treatment inside hospitals.

“A lot of people are saying home is going to be a replacement for the hospital. I think that’s incorrect,” McCann says. “There are lots of people who need to be inside hospitals. The inpatient environment is always going to be a location where care needs to be delivered.

“The thing for me is, is there a percentage of care that’s in-patient today, that could be delivered in the home,” he adds. “I think we’ve seen definitively over COVID, that is true.”

Part of Current Health’s focus is going beyond acute care to chronic disease management at home, and post-acute transitional care.

“Health systems don’t want niche solutions for individual populations,” McCann says. “They want one solution that can support them across the enterprise."

"Patients don't just live in these silos,” he says. “We want to follow them when they go from hospital at home to chronic care, and back to hospital at home, and give the consumer one integrated experience, not a bunch of fragmented experiences, but one experience that follows them through their journey.”

 showing good outcomes for patients in hospital-at-home programs, including reduced readmissions.

Nonetheless, some healthcare leaders have been reluctant to invest in hospital-at-home programs and other technology initiatives based in the home. While many healthcare leaders see the potential of such initiatives to improve patient care, many don’t identify expanding offerings to the home as a top priority, according to 

 of healthcare executives by Sage Growth Partners. Some are also waiting for more assurance about long-term federal reimbursements.

Still, patients are indicating they want more care options at home, and healthcare leaders should consider patient preferences, McCann says.

“In the future, consumers are going to select their providers based on who offers these services and who doesn’t,” McCann says. “You have to do it now, because otherwise, you’re going to be five years behind.”

While there are technology demands in implementing hospital-at-home programs, they aren’t the most formidable challenge, McCann says.

“I say this as a technology leader, the technology is not the most important part of this,” McCann says. “It’s making sure you have broad buy-in across the organization.”

Hospital executives need to make sure home hospital programs are a key priority and not just a side project, he says.

“It needs CEO-driven buy-in,” McCann says. “It needs clinical leaders, it needs nursing leaders, it needs IT leaders and they all have to be bought into it together.”

Hospitals have to establish clinical workflows and select the right patients. Some patients may be too ill and need to be inside the hospital.

The most successful home hospital programs also have strong leadership from nurses, McCann says.

“They are playing a really significant role in running the programs at the management level, helping identify patients … and spending a lot of time in the home with those patients,” he says.

Nurses who participate in home hospital programs have reported greater job satisfaction, which McCann calls a welcome surprise.

“They’re actually able to go in and deliver care in the way that they can,” he says. “If they have eight patients on a floor, and they’re getting paged every two minutes, and they’re being called away, they can’t spend significant time with that patient.”

McCann says the programs won’t lead to nurses being replaced, saying they are critical to making hospital-at-home work.

“These programs are only successful with amazing nursing and medical teams,” he says.

“We have to kill the phrase ‘virtual care’,” he says. “It’s not virtual, it’s still physical care. And we need nurses to go into the home and deliver care. It’s not ever about replacing the staff.”

Ultimately, McCann says Current Health’s success will be built on showing health systems the clinical and economic case for hospital-at-home programs and their success in patient care and satisfaction.

But he says the other key ingredient comes in satisfying a constituency that is often overlooked: the providers.

“The experience for them has to be amazing,” McCann says. “It has to be easier for them to do this than put a patient on the floor, or they won’t do it.

“We have to make the provider and the clinician experience incredible, and I don’t think there’s been enough focus on that last part,” he adds. “They’re kind of left out, and I think that’s a mistake.”

He talks with Chief Healthcare Executive about the growth of hospital-at-home programs, Best Buy’s purchase of Current Health, and how leaders can help make home-based care succeed.

Current Health CEO Christoper McCann says care is coming home

As doctors and nurses face more violence in hospitals, health systems have encouraged clinicians to utilize a notification or “flag” in health records to indicate that patients may be potentially unsafe or aggressive.

However, a new study indicates that Black patients are more likely to receive a flag in their electronic health records than white patients.

Researchers with the University of Pennsylvania found Black patients with a flag received less treatment, were less likely to be admitted, and were more likely to leave before a full evaluation than white patients. The findings were published in 

“Behavioral flags have important implications for patient care: they may introduce cognitive bias from clinicians providing acute care, since they often serve as alerts or advisory notifications when opening a patient’s EHR,” the researchers wrote. 

“Understanding when, and for whom, these flags are being implemented is important in how health systems think about providing equitable care while maintaining staff safety.”

Black, Latinx patients had greater delays in cancer care in pandemic

Very few patients are being flagged in electronic health records, the researchers found.

Among 195,601 patients studied in emergency departments, only 683 patients (0.3%) had a behavioral flag notification in their electronic health records.

However, Black patients were nearly twice as likely to get a flag in their records. Black patients received the notifications at a rate of 4 per 1,000 patients, while white patients received flags at a rate of 2.4 per 1,000, according to the study.

Among those with a flag, Black patients waited 28 minutes to be placed in a room, while white patients with a notification waited 18 minutes. Black patients with a flag spent more time waiting to see a clinician than white patients (42 minutes vs. 33 minutes). And Black patients were more than five times more likely to have no laboratory orders, the study found.

The researchers said the greater use of flags for Black patients suggests bias could be a factor.

“Questions also arise from this study as to why Black patients were more likely to be flagged; the reasons for this, including structural factors and racial bias, require further study,” the researchers wrote. “This analysis demonstrated that flags were associated with care, which may in turn be associated with diagnostic error.”

Health systems understandably want to do more to protect healthcare workers. 

Most emergency doctors said they have seen increased violence in the last five years

, according to a poll by the American College of Emergency Physicians. 

Roughly half of all nurses report an increase in workplace violence

, according to a poll by National Nurses United.

The disparities in using flags in health records represent an unintended consequence of a policy aimed at protecting doctors and nurses, the researchers noted.

To avoid bias, health systems could consider using a team approach to determine if a patient’s record should include a notification about a potential problem, the authors wrote. Researchers also suggested removing the flags from records if patients exhibit no problems in subsequent visits, or setting a time limit on how long the flags should remain in the health records.

Researchers examined three emergency departments in Philadelphia between Jan. 1, 2017 through Dec. 31, 2019.

Electronic health records have revealed suggestions of bias in the past. 

Black patients were more than twice as likely to have at least one negative description in their health records

 than white patients, according to a study published in 

A new study finds that Black patients are more likely to wait longer and receive less treatment. Researchers say the alerts can have implications in patient care.

Black patients more likely to be flagged as aggressive in emergency departments

Students and parents scour the rankings produced by U.S. News & World Report when choosing schools, but one major name is no longer participating in the rankings.

Harvard Medical School said last week that it would no longer submit data for the U.S. News ranking of the best medical schools.

 to the campus community, George Q. Daley, dean of Harvard Medical School, said he had been pondering the move since becoming dean six years ago. Daley noted growing concerns about the methodology of the U.S. News rankings, but he said his concerns were more philosophical.

“As unintended consequences, rankings create perverse incentives for institutions to report misleading or inaccurate data, set policies to boost rankings rather than nobler objectives, or divert financial aid from students with financial need to high-scoring students with means in order to maximize ranking criteria,” Daley wrote.

“Ultimately, the suitability of any particular medical school for any given student is too complex, nuanced, and individualized to be served by a rigid ranked list, no matter the methodology.”

Medical schools see dip in applicants, but more diversity

It’s not as if Harvard Medical School was lagging in the rankings. Harvard ranked first in the U.S. News 2023 ranking of 

Still, Doyle said it’s his belief that “rankings cannot meaningfully reflect the high aspirations for educational excellence, graduate preparedness, and compassionate and equitable patient care that we strive to foster in our medical education programs.”

The rankings have had their critics, but Harvard Medical School’s move gained 

. Colin Diver, former president of Reed College, told 

 that the move is significant, as Harvard’s dean “recognized that a boycott of the U.S. News can only work if it comes from the top.”

Nonetheless, many people turn to the rankings when looking at schools, and institutions use the rankings in marketing themselves to prospective students.

Eric Gertler, U.S. News executive chairman & CEO, said the rankings offer valuable guidance to students and families in making decisions on where to go to school.

“We know that comparing diverse academic institutions across a common data set is challenging, and that is why we have consistently stated that the rankings should be one component in a prospective student’s decision-making process,” Gertler said in a 

“The fact is, millions of prospective students annually visit U.S. News medical school rankings because we provide students with valuable data and solutions to help with that process."

Still, the rankings have gained growing criticism recently. 

Columbia University took some heat after allegations that it submitted inaccurate or misleading data to the U.S. News ranking of the top colleges, 

 reported. Columbia said it miscalculated data, and U.S. News dropped the university from number 2 to number 18. But the furor added fire to questions about the value of the rankings and how easily they can be skewed.

Some top law schools have said they will no longer participate in the rankings, including 

. Doyle cited the decision of John Manning, dean of Harvard Law School, as a factor in his move to stop participating in the rankings.

Yale Law School Dean Heather Gerken said the rankings disincentivize programs that support public interest careers and offer need-based aid.

“While I sincerely believe that U.S. News operates with the best of intentions, it faces a nearly impossible task, ranking 192 law schools with a small set of one-size-fits-all metrics that cannot provide an accurate picture of such varied institutions. Its approach not only fails to advance the legal profession, but stands squarely in the way of progress,” Gerken said in a statement.

Doyle noted that comparable data for all U.S. medical schools can be found on the Association of American Medical Colleges website, which includes the 

Medical School Admission Requirements (MSAR) Reports for Applicants and Advisors

The institution joins some top law schools in abandoning the rankings. U.S. News says the reports provide a valuable service to students, and many schools tout high rankings in their marketing.

Rank and bile: Harvard Medical School won’t participate in U.S. News ratings

Adam Steinberg is executive vice president of customer experience at Experity

The role of urgent care in the broader healthcare landscape has become increasingly important over the past few decades but has become notably prominent following the COVID-19 public health emergency that solidified the need for, and value of, on-demand care for the masses. 

As a result of the urgent care industry’s impressive ability to pivot during the pandemic and the influx of demand that came with it, urgent care providers are now faced with new, unprecedented growth opportunities.

With daily patient visit volumes reaching record highs at urgent cares across the country, clinics are learning how to not only accommodate this high demand and ensure care is accessible to all who need it, but to also ensure that patients return for future treatment beyond COVID-19 related care – as patient retention has become a top priority for the continuous growth and sustainability of urgent care businesses.

To make the most of these new patients and keep visit volume up, urgent care clinics must take new, strategic approaches to continue nurturing the relationships they built during the pandemic and ensure they are delivering the level of care quality and patient experience that will encourage patients to return. 

To best capitalize on the opportunities now available to U.S. urgent care providers due to growing demand and visit volume, clinic leaders can explore a few key areas that can have the most significant impact on their clinics.

Identifying opportunities to strengthen operational foundations

Convenience and efficiency, while maintaining high quality, high velocity care, are fundamental to the success of urgent cares, as it is those core components that set them apart from all other providers in the healthcare ecosystem.

To effectively maintain these core components while managing high visit volumes, it is important to get back to basics to identify any operational inefficiencies that could deter a clinic’s performance. Solid operational foundations and standard operational procedures (SOPs) are a necessity for urgent care businesses to provide more patients with efficient and high-quality care.

SOPs, when developed comprehensively and followed tightly, ensure everyone working at a clinic is operating based on a formalized, coordinated process, which helps to reduce the risk of error and improve productivity, resulting in a higher quality care experience for a clinic’s growing number of patients. If SOPs are weak, owners and operators will feel the impact of that through slow throughput, staff burnout, poor patient satisfaction and other metrics.

SOPs must be extensive and cover every fundamental function that an urgent care practice performs, from blood draws to patient check-ins, billing processes, and more. All of these functions should have a procedure in place that is informed by industry best practices and understood and followed by the staff. 

Taking the time to ensure every facet of an urgent care’s operation is functioning properly is essential to expand the practice and retain and grow the population of patients served, as it facilitates a clinic’s ability to deliver care as it was intended — high quality, with urgency.

When COVID-19-driven visit volumes were at their peak, the importance and value of automation became abundantly clear.

For urgent care practices, electronic medical record and practice management (EMR/PM) is the core software used to manage information, but when combined with integrated patient engagement solutions, for example, clinics can fully streamline the patient visit from first contact through discharge, helping to register patients, collect patient information, and document visits.

To boost staff efficiency, clinics must lean on vendor partners to ensure their platforms are updated, functioning properly and are being used optimally. Additionally, there are often numerous other opportunities waiting for clinics to simplify their workflows, remove complexities, and eliminate administrative burden through automation.

Today’s patients want a simpler, digitally enabled experience, and providers want more bandwidth back to focus on the patients that need care. Integrated automation solutions help to remove complexities, leading to better experiences, increased customer satisfaction, and bringing new patients back to urgent care practices for non-COVID related on-demand care.

Turning new patients into repeat patients is dependent upon providing them with high quality care and positive experiences. To maintain high visit volumes brought on by COVID-19, clinics must connect with patients before, during and after the visit to develop a foundation of trust using modern patient engagement technology that fully integrates EMR/PM software.

Clinics must take new approaches to nurture the relationships they built during the pandemic and ensure they are delivering the experience that will encourage patients to return.