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A new healthcare IT-focused thriller, written by a longtime health system leader, involves a hack into a national electronic health record system. The novel, Coded to Kill (Post Hill Press), is focused around two themes that can sometimes be at odds: maintaining patient privacy while driving toward nationwide interoperability.
The characters at the fictional company developing the for-profit nationwide EHR are “susceptible to thinking it’s better than it is,” explained author, Dr. Marschall Runge, who serves as executive vice president for medical affairs for the University of Michigan, dean of the Medical School and CEO of the Michigan Medicine health system.
In Coded to Kill, a technically feasible plot focuses on a cyber exploit that compromises patient privacy – to deadly results – at the fictional, North Carolina-based “Drexel Hospital.”
With the hospital’s cutting-edge EHR about to “become the national standard,” nefarious characters launch a plan to compromise its data in order to murder a politician. Meanwhile, other suspicious patient deaths keep occurring.
Runge told Healthcare IT News that he got the ideas for the book from real-life insider data breaches perpetrated by some employees working at the University of North Carolina more than a decade ago.
“We were having all kinds of problems with people,” he said. “Faculty and staff inappropriately accessing medical records.”
Runge said he had the task of speaking with faculty – and found that close to 90 people had inappropriately logged into certain records.
“And so it really brought to my attention, this is a big problem,” he said.
At Michigan Medicine, artificial intelligence is used to screen every medical record for improper access, Runge said.
But the problem of inappropriate system access is still a challenge at many other providers nationwide, and privacy breaches continue across healthcare.
“There are many, many instances now of inappropriate hacking into medical records,” he said, noting, for instance, that the breach of Change Healthcare may have compromised up to 60% of U.S. citizens with medical insurance.
“There’s a great promise, and I think a great peril, in electronic medical records,” said Runge.
“The ability to look at medical records to look for patterns and trends, and particularly using AI to broadly help us in early detection of pandemics,” are two examples of a positive benefit, he said.
And finding people who have a rarer disease could accelerate improved therapies, he added.
But having digital medical records “comes at a price,” With the U.S. healthcare sector now a prime target for cyberattacks, the topic of data security “is even more appropriate today than it was when I started to write the novel,” about 15 years ago, he said.
Creating medical records systems that become vast attack surfaces allows for the chance that criminals or other cyber bad actors could uncover information that could be lethal to a patient, he said.
In the Coded to Kill, for example, drug lists are corrupted, because the goal of “subterranean hackers” is to physically harm their targets. While medical records are often well protected from cyber intrusions, Runge noted, it is technically possible for a hacker to change information.
At the beginning of Chapter 17, characters cook up a scheme to test the killing capacity of Drexel’s EHR by erasing a patient’s genetic weakness from the system.
Another example Runge chose was around pharmacies using pharmacy robots, which have come into use in the last five years, as a plot element.
“They’re more accurate than people, but because the pharmacy robots are ultimately connected to the electronic medical record, somebody could get in there and say, ‘Marschall is in the hospital. We know he’s allergic to penicillin. Let’s give him a big slug of penicillin … and you know, he’ll die.'”
In the book, the hackers also use AI to scan medical records and find medical vulnerabilities, including in patients’ genomic data.
Runge, a cardiologist, started writing his thriller – which mixes murder, mystery and politics – a decade and a half ago, when many hospitals were still using paper records.
Since then, EHR use is near ubiquitous – and the idea of creating and securing a national system of real-time medical records is not as far-fetched as it may have once seemed.
In the book, all U.S. patient records live in a nationwide cloud-based EHR that leverages AI to identify emerging diseases and improve care delivery.
Such an EHR could be very useful in getting ahead of a pandemic, improving decision-making for doctors across the country and potentially improving patients’ access to their complete medical records, Runge said.
When he started writing, “there wasn’t much of the notion that you could connect attributes to people and their illnesses with their genetics and genomics,” Runge said. “That was just pie in the sky when I started out. Now it’s a reality.”
Runge separately asserted in our conversation that, if a national electronic health record had existed, the healthcare sector would have foreseen that COVID-19 pandemic was hitting the United States months before it did.
He’s not the only person who feels that way. Healthcare data fragmentation has “caused tremendous problems,” as Oracle cofounder and Chief Technology Officer Larry Ellison noted two years ago, shortly after his company acquired EHR giant Cerner.
During the early days of the pandemic, emergency doctors were unable to retrieve critical information from disparate EHR systems and public health officials had little visibility into how care resources were being used, he noted.
“We’re going to solve this problem by putting a unified national health record database on top of all of these thousands of separate hospital databases,” Ellison pledged.
Whether and when that occurs remains to be seen. But for any vast unified network or database of medical records – national or otherwise – robust cybersecurity controls must be a foundational part of the equation, said Runge.
In reality, as well as in fiction, cybersecurity must be as high a concern as interoperability.
“There’s nothing that’s not technically possible,” said Runge, “and that’s why we have to continue to do everything we can to build our cybersecurity around the systems.”
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
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JERUSALEM — A deadly Israeli airstrike on a tent camp in Rafah late Sunday drew widespread international condemnation Monday — focusing further scrutiny on Israel’s controversial offensive against Hamas in the south and the desperate plight of Gaza’s civilians.
Witnesses described a horrific scene late Sunday as fires tore through the makeshift encampment in the Tal al-Sultan neighborhood, killing at least 45 people, according to the Gaza Health Ministry. Parents were burned alive in their tents while children screamed for help. Doctors recounted struggling to treat gruesome shrapnel wounds with dwindling medical supplies.
In an address to parliament Monday, Israeli Prime Minister Benjamin Netanyahu called the Rafah strike a “tragic accident.” It was a departure from public statements by the Israeli military, which had previously referred to a targeted strike on a Hamas compound using “precise munitions” and “precise intelligence.”
The Israel Defense Forces said two militants were killed in the attack, including the commander of Hamas operations in the West Bank. “There were many measures taken before the attack to minimize harm to non-involved people,” the IDF said Monday, adding that the incident was under investigation.
Summarized stories to quickly stay informed
A spokesperson for the White House National Security Council, speaking on the condition of anonymity to discuss a sensitive matter, said the images from Rafah were “heartbreaking.” “Israel has a right to go after Hamas,” the spokesperson said, noting the killing of the two militants, but “Israel must take every precaution possible to protect civilians.”
The United States has yet to weigh in publicly on Friday’s ruling by the International Court of Justice ordering an immediate halt to Israel’s offensive in Rafah. Nearly a million Palestinians have been displaced this month, the vast majority from Rafah, which had been a place of last refuge for tens of thousands of families.
On Sunday night it was the site of one of the most horrifying scenes of the war.
Mohammad Al-Haila, 35, was headed to buy some goods from a local vendor when he saw a huge flash followed by successive booms. Then he saw the flames.
“I felt like my body was freezing from fear,” Haila, who was displaced from central Gaza, told The Washington Post by phone.
He ran toward the area to search for relatives.
Displaced Palestinians searched through ashes after dozens were killed and dozens injured in Israeli strikes on a tent camp in Rafah on May 26. (Video: The Washington Post)
“I saw flames rising, charred bodies, people running from everywhere and calls for help getting louder,” he said. “We were powerless to save them.”
Haila lost seven relatives in the attack. The oldest was 70 years old. Four were children.
“We were not able to identify them until this morning because of the charred bodies,” he said. “The faces were eroded, and the features were completely disappeared.”
Ahmed Al-Rahl, 30, still hears the screams.
He and his family were preparing for bed when they heard several large explosions, said Rahl, who is displaced from the north. Their tent shook. Mass confusion took over the camp.
“No one knew what to do,” he said. “Children who were with their families in those tents rushed to us, asking us to save their parents who were burning.”
Rahl had a fire extinguisher and rushed to help.
“I didn’t know what to do to help people as they burned,” he said. Around him there were “dismembered bodies, charred bodies, children without heads, bodies as if they had melted,” he said.
There was no water to extinguish the fire, which consumed the cloth and plastic tents. Gas canisters used for cooking exploded, Rahl said.
“I saw with my own eyes someone burning and crying for help, and I could not save his life,” he said.
An Israeli strike on a camp for displaced Palestinians killed dozens in Rafah on May 26. (Video: Julie Yoon/The Washington Post)
Mohammad Abu Shahma, 45, rushed to check on his extended family when he heard that the fire was spreading. His brother’s tent was about a quarter-mile from the worst of the carnage. Shahma figured he must be safe.
He found his brother, a father of 10, and his 3-year-old niece, Palestine, dead. There was blood everywhere, Shahma said. Shrapnel had struck his brother in the chest and neck; the child had been hit in the head. Another daughter, 9-year-old Jana, was injured.
Around 10 p.m. Sunday, the dead and wounded began pouring into the area’s few field clinics.
Twenty-eight people were dead on arrival at a temporary emergency trauma center run by Doctors Without Borders less than two miles from the strike site, according to Samuel Johann, the group’s emergency coordinator in Gaza. The clinic treated 180 additional patients with severe burns, shrapnel wounds, missing body parts and other traumatic injuries, he said.
Farther west, at a clinic run by International Medical Corps, plastic surgeon Ahmed al-Mokhallalati described family members searching desperately for loved ones.
One little girl, he said, was asking everyone she passed if they had seen her parents. Mokhallalati said they were among the dead.
Many people came in with horrific wounds and required amputations, he said, as shrapnel flew across the camp and pierced people’s tents. Over a grueling, relentless night, he and his colleagues conducted at least 12 hours-long surgeries, Mokhallalati said.
They ran out of medical gloves, gowns and other basic supplies to treat open wounds. “We are running out of everything, literally,” he said
Patients needing further care had few places to go, he said. Rafah’s two main hospitals have been evacuated. The smaller Kuwait hospital said Monday that it had to close after repeated attacks. One of the only options left was al-Aqsa Martyrs Hospital, a rough ride away in central Gaza.
Mokhallalati recounted operating on a 6-year-old girl with deep shrapnel wounds that stretched from her thigh to her abdomen. She died early Monday morning, he said.
The makeshift camp in Tal al-Sultan was outside Israel’s designated evacuation zone in Rafah, and residents were not ordered to leave before the strikes.
The area was at the edge of, but not included in, a map of humanitarian zones provided by the IDF online and in recent announcements. Gazans, however, short on bandwidth and cellphone battery power, often rely for information on word-of-mouth and Arabic-language pamphlets dropped by the IDF. Residents complain that the evacuation orders and accompanying maps are confusingly worded and difficult to follow. Many believed they were in a safe place.
In its statement, the IDF said “the attack did not take place in the humanitarian area in Al Mawasi,” referring to a coastal region northwest of Rafah where it has ordered evacuees.
New arrivals to Mawasi have told The Post the area is desolate, overcrowded and devoid of even the most basic services. Some families, many who have already been uprooted numerous times during the war, decided to stay in Rafah.
French President Emmanuel Macron said Monday that he was “outraged by the Israeli strikes that have killed many displaced persons” and called for “an immediate cease-fire.”
Canadian Foreign Minister Mélanie Joly also demanded a cease-fire, saying, “This level of human suffering must come to an end.” A spokesperson for the ministry said the country was following up on reports that two Canadian citizens were among the dead in Rafah.
The Foreign Ministry in Germany, one of Israel’s most stalwart supporters in Europe, said in a statement on X on Monday that the images from the attack were “unbearable” and that “the civilian population in Gaza must urgently be better protected.”
Shahma spent Monday packing up. His extended family of 50 people had decided that women and children would move to Mawasi, he said, and the men would stay in nearby Khan Younis.
“We did not even find time to grieve for those we lost,” he said. “All that matters to us now is to save those who remain.”
Haila spent the day searching scorched corpses at the clinic in Tal al-Sultan for any sign of his missing family members.
“What we live in this life cannot be described,” he said. It was like being “on the waiting list” to die.
Harb reported from London. Sarah Dadouch in Beirut, Rachel Pannett in Wellington, New Zealand, Niha Masih in Seoul, Lior Soroka in Tel Aviv, Hazem Balousha in Cairo, Amanda Coletta in Toronto and Tyler Pager in Washington contributed to this report.
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