July 5, 2011

July 5, 2011Hi All,The following is this week’s edition of the Dell Services weekly Washington Report.Information and updates in this report include:  Quote of the Week  Indicium Brevis- Ongoing snippets of information for your consideration…  Are You as Secure as You Think?- By Jon Ramsey, Executive Director of the Counter Threat UnitSM (CTU) research group at Dell SecureWorks  Next Stop: The Supreme Court- With the Sixth Circuit Court of Appeals ruling in favor of healthcare reform’s individual mandate this week, what does this mean for the country?  Lieberman and Coburn to the Rescue?-Could this unlikely duo be the answer to America’s Medicare problem?  Health IT Roundup- A weekly digest of the latest health technology developments.Quote of the Week“We find that the minimum coverage provision is a valid exercise of legislative power byCongress under the Commerce Clause.”Justice Boyce F. Martin, Jr. of the Sixth Circuit Court of Appeals, which ruled this past weekthat healthcare reform’s individual mandate is constitutional.Indicium BrevisOngoing snippets of information for your consideration…Insured Patients Being Turned Away – A recent analysis in the Archives of InternalMedicine shows an alarming trend for the medical community. Reporting that more insuredindividuals are finding it harder to seek primary care, the study showed a 5.5 percent drop inpatients being able to find a doctor. This is a scary statistic for the medical community asnow 87.8 percent reported being able to access a physician. With more patients entering thesystem as a result of healthcare reform and less than ever being trained, it seems we are instore for a major problem.Mortality Rate For Gen X – While it’s clear that today’s “Generation X” has a host of healthproblems, including obesity, smoking and lack of exercise, what is not yet known is howlong “Gen X” will live. According to a new study featured in Health Affairs, the traditionalmodel of projecting this generation’s life expectancy is outdated. While taking intoconsideration a new “three-dimensional” formula that calculates the many health risks

young people are subject to, the study found that Generation X could live far less than manypredict. With obesity rates continuing to climb, researchers believe America’s young adultscould live decades less than some now believe…And In Honor Of The Holiday – According to a new study from the Substance Abuse andMental Health Services Administration, underage males are twice as likely to visit theemergency room for alcohol related issues during the Fourth of July weekend. Though NewYear’s Eve still tops as the most “dangerous” holiday, let’s hope everyone had a very safe andenjoyable Independence Day without having to interact with America’s healthcare system.Are You as Secure as You Think?By Jon Ramsey, Executive Director of the Counter Threat UnitSM (CTU) research group at DellSecureWorksYou might think a company’s computers would be one of the safest places to surf theInternet, bank online, answer e-mails and save private data, but companies are huge targetsfor cyber criminals. Government agencies, national banks, retail chains, healthcareorganizations and even giant technology companies have all been hacked.The threat landscape continuously changes for organizations. Below, in Diagram 1, whichshows the attack landscape for 45 of the 104 healthcare organizations that Dell SecureWorksprotects, you can see the types of cyber-attacks greatly vary. 1 In the first quarter of 2011,our healthcare customers experienced 20 percent more attempted attacks per customerTCP/IP address (approximately 136 attack attempts per customer IP), than our customers inthe retail, banking, credit union and utility sectors. They experienced an average of 114attempted attacks per TCP/IP address. The spikes in attacks in diagram 2 are due to surges inspecific types of attacks. Diagram 1

Diagram 2You may wonder why healthcare companies experience so many attacks. For one, theirnetworks are more open than other networks because doctors and other medicalprofessionals need easy access to diagnose a patient’s ailment and must take swift and safeaction. Cybercriminals are aware that medical networks are more open and target theselooking for access to patients’ financial and personal data, such as social security numbers,banking data, age, home addresses and more, allowing cybercriminals to steal the identity ofpatients and use it for financial gain.But whether an organization is in the healthcare industry or in another industry, noorganization is exempt from cyber-attacks. Unfortunately, there is not one sole product orservice provider that can guarantee 100 percent safety from hackers. However, there arenumerous steps companies can take to make their networks and servers such a difficulttarget to reach that hackers give up and move on to easier prey.Simple But Effective IT Security PrecautionsSome companies have deployed nearly all the security devices and solutions in existence toprotect themselves. Yet, they miss the mark on taking simple precautions, such asimplementing computer policies. Staff members need company policies that protect themand the company, and are easy to abide by. While it is smart to change passwords often andhave minimum character requirements, when employees need to create difficultpasswords—say a 10-character password—and change it every month, it causes havoc.Employees often end up writing down their passwords and keeping them at their desk,making it easy for someone to find them and access the network.

A lot of hacking is brought about by “social engineering,” a term that means an outsider hasmanipulated a computer user into performing tasks that ultimately divulge information. Forexample, a hacker could send a company employee an e-mail asking him to click on a linkor open an attachment. One click on a link or an attachment could dispel a piece ofmalware—malicious software—that enters the computer. Once that malware is on thecomputer, it could allow a hacker to see every document on that computer, track every keystroke of its user, and worm its way into the network.Whether an organization’s servers are located in-house or in the cloud, most companiesknow they need multiple firewalls, e-mail gateways and intrusion-detection and/orintrusion-prevention devices (IDS/IPS). But often these devices are not configured optimallyand sound false alerts, sending security staff in umpteen directions, averting them from realthreats. Companies should engage with information security professionals to confirm thatcomputer devices are properly configured and are maintained to ensure optimumperformance.Sometimes the threat to a company comes, unintentionally, from employees who plug ininfected devices into the network. Company security teams should have a map of theirnetwork and all its connected devices. Security teams should implement controls thatprohibit unauthorized devices from joining the network. That way, if someone were to plugin an unauthorized device, like a mobile device, the mechanical controls in place wouldprevent the device from connecting to the network.No matter how much security a company has provided for its environment, if the software itis using has vulnerabilities in it, the network could be open to attack. Security teams shouldcontinually evaluate risks and apply patches as quickly as possible, starting with the mostrisky vulnerabilities. Ongoing vulnerability assessments of a company’s network andapplications can greatly assist in spotting the vulnerabilities that could potentially lead todata loss.It is the accumulation of many layers of protection combined with threat intelligence thathelps keep companies safe. Companies must have security professionals guarding them24x7x365. That way, if malware worms its way into a system, the security team can spot itimmediately, disconnect it, and stop the intruder from accessing the network, where storedintellectual property, client information and financial data could potentially be compromised.For more information on IT security solutions, visithttp://www.secureworks.com/compliance/industries/healthcare.1 Dell SecureWorks studied 45 of its 104 healthcare clients over three months using our ManagedIntrusion Detection and Prevention services (IDS/IPS) at the edge of each customer’s network,which gives us visibility into all attempted network attacks and allows us to block them.

Next Stop: The Supreme CourtWith the Sixth Circuit Court of Appeals ruling in favor of healthcare reform’s individualmandate this week, what does this mean for the country?Well, that didn’t take long. Just a mere 29 days after hearing oral arguments in the legalbattle challenging the Affordable Care Act’s “individual mandate” the Six Circuit Court ofAppeals ruled in favor of the government, thus finding the mandate constitutional. What hasbecome the central fight against healthcare reform since the law’s passage, critics havecontended that forcing citizens to purchase insurance coverage is an illegal use ofgovernment power while supporters disagree. Though the issue has bounced throughoutlower courts the past year, this week’s decision means the lawsuit’s next stop is the SupremeCourt. Now the nation’s highest court will finally be forced to decide once and for all if theAffordable Care Act is constitutional most likely sometimes in the fall.In a decision that surprised many legal analysts, the Sixth Circuit favorable ruling was a clearshift in direction from a group of justices that many see as right-leaning. With the three-judge panel ruling 2-1 in favor of the mandate, Jeffrey Sutton, a George W. Bush appointedjudge and former law clerk for conservative icon Justice Antonin Scalia found the provisionto be constitutional. Marking the first Republican-nominated justice to find the individualmandate legal, Sutton’s decision will weigh heavily on the conservative bloc of the SupremeCourt in making their own ruling. We should expect that his name will be mentioned moreoften as the country inches closer to a final ruling from the high court.With the Sixth Circuit also taking just 29 days to announce their decision, the panel’s speedalmost assures that the Supreme Court will open oral arguments this fall. This timing is ofhuge significance to the country. With the case set to begin in earnest by October, a decisionwill not likely be announced by mid-summer, and thus in the dead heat of what is lookinglike a competitive presidential campaign. What could very well become a “game changing”moment in the 2012 race, the Supreme Court could become an ally or even possibly a thornin the side of President Obama’s chances of being reelected. Next summer’s ruling mightshake things up more than we can ever imagine.But in terms of sheer legal analysis, a victory in the appellate court is a step in the rightdirection for health reform supporters. The Supreme Court, though not afraid to overturn theSixth Circuit’s decision, will look very closely at the logic behind how the three justices ruled.By examining the calculus behind their decision, the high court will use the appellate judges’arguments in shaping their own opinions, and despite the political ramifications, the 2-1 splitwill also weigh heavily in how the Supreme Court decides to rule.“We find that the minimum coverage provision is a valid exercise of legislative power byCongress under the Commerce Clause” wrote Justice Boyce F. Martin, Jr. in his concurringopinion this week. With the Supreme Court likely to begin listening to arguments this fall, wecan be assured that this statement will be given incredible scrutiny as the future ofhealthcare reform, and perhaps a presidential election, hang in the balance.

Lieberman and Coburn to the Rescue?Could this unlikely duo be the answer to America’s Medicare problem?Sometimes in politics, much like in life, opposites attract. An age old philosophy that hasbrought countless people together, it seems as if this past week we witnessed this firsthand.Though on polar opposite sides of the political spectrum, Senators Joe Lieberman (I-CT) andTom Coburn (R-OK) have teamed up to submit their own proposal on how to fix America’sMedicare problem. While saying it would trim roughly $600 billion off the cost of Medicarethrough the next decade, is this what the nation has been waiting for?Under the new Lieberman-Coburn plan, Medicare eligibility would begin to increase from 65to 67 starting in 2014. Assuming that much of Congress’ healthcare reform plans remain,senior citizens would then be eligible to find health coverage through exchanges createdunder the Affordable Care Act. This would offset the cost of Medicare, allowing elderlypatients the ability to find quality low-cost healthcare without a problem. Next, the planwould gradually increase the premiums seniors would pay for Medicare Part B (which paysfor physician visits) by 2 percent a year for five years until they cover about roughly 35percent of the program’s cost. Wealthier patients, meanwhile, who earn $150,000 for anindividual or $300,000 a couple, would pay the full premium of $400 a month.Furthermore, the plan will institute a new single Medicare deductible of $550 and set anannual out-of-pocket maximum of $7,500 with the hope of protecting seniors againstmedical bankruptcy. While finally establishing a three year fix to the sustainable growth rate,both Senators Lieberman and Coburn believe their idea is a pragmatic approach to solvingthe Medicare challenge. But yet, not surprisingly, no one in Washington likes it! The plan hasalready been attacked by senior citizen groups who are against paying more for theirhealthcare and chastised by Democrats for raising the eligibility age.But, regardless of the pushback from members of Congress, both Lieberman and Coburn arevowing to push forward. Still, the duo might be on to something. As stated previously, thelawmakers are on separate ideological sides but yet have put their differences aside to workconstructively in order to create a solution. This bipartisan effort ought to be encouraged.Though certainly not perfect, the Lieberman-Coburn proposal is a step in the right directionof finally settling the Medicare debate once and for all. Such debates don’t need to be hostileor partisan. In fact, the best decisions are made by taking into consideration a wide array ofviews. With this formula in mind, let’s hope for the best as they now begin the process ofselling their proposal to their fellow bipartisan-minded colleagues.Health IT RoundupA weekly digest of the latest health technology developments.CMS To Streamline Insurance Eligibility Data – The Centers for Medicare and MedicaidServices this past week released their interim final rule that sets standards for two electronichealth transactions. The first, which focuses on how a physician might inquire on a patient’sinsurance eligibility, and the second, which focuses on the status of a submitted insuranceclaim, are crucial steps in promoting health technology in the healthcare community. Withthe hope of providing more clarity to physicians, CMS’ new rule will allow for greater accessto information and a faster approval process.

HIMSS Issues New EHR White Paper – The Healthcare Information and ManagementSystems Society, better known as HIMSS, released a new white paper this past week focusingon the strategies needed to develop a health information exchange. By citing several casestudies the organization led, the paper helps readers understand best practices inestablishing a HIE and connecting electronic health records efficiently and effectively. As thegovernment continues to approach “Stage 2” of meaningful use, this paper is likely to receiveeven more attention.VA To Allow More Mobile Technology – In yet another sign of the strides mobiletechnology has made over the past few years, the Department of Veterans Affairs this weekannounced they would allow its physicians to use smartphones and tablets in working withpatients. Though the devices will have to be encrypted with security software, the VA ishoping that their decision will increase the quality of care while allowing doctors someneeded flexibility. Beginning October 1, physicians can chose from a variety of deviceoptions and be able to connect to the VA’s secure health information system.For Past UpdatesFor past editions of the Washington Report, click here. Also, follow DellHealth on Twitter atwww.twitter.com/DellHealth. To contact me, send an email toAsk_Dell@Dell.com.

July 5, 2011

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July 5, 2011 Document Transcript