FirstHealth of the Carolinas

A masked man checks the blood pressure of an african american patient

The doctor will see you now, at work

December 1, 2020 by Liora Engel-Smith

The doctor will see you now, at work - North Carolina Health News

Amid the rising cost of health care, a mobile clinic provides free basic medical care to workers at a factory in rural Montgomery County.

By Liora Engel-Smith

The semi-trailer that’s become a staple in the McRae Industries parking lot has nothing and everything to do with making shoes. The white and green truck doesn’t deliver leather for boots, nor does it shuttle uppers to a nearby sewing factory.

But people here say the two-axle vehicle is every bit as essential to the smooth operation of the factory at Mount Gilead, a Piedmont-region rural town of just under 2,000. The 300 employees here cut and sew leather for what will become boots for the U.S. and Israeli militaries. Workers in another McRae facility four miles north of Mount Gilead finish the boots and add soles.

The semi that visits the factory in Mount Gilead once a week is a mobile clinic. It comes fully equipped with a waiting and triage area, a sink and bathroom and an exam room. It’s also staffed with a physician assistant and a licensed practical nurse who provide basic primary care, from tests to blood pressure and diabetes screenings to medication refills and treatment of minor infections.

A mobile clinic van is parked in front of a red brick building — FirstHealth’s mobile clinic serves several local businesses. The service, which employers purchase, providing primary care services to employees for free. Photo credit: Liora Engel-Smith

The service is free for employees. There are no copays or health insurance requirements in order to be seen. Hourly employees don’t even have to clock out before they come to the trailer at the edge of the parking lot. McRae pays a flat daily fee for the clinic, which belongs to Pinehurst-based health care network FirstHealth of the Carolinas.

As health care costs soar for both employers and employees, keeping the bottom line in check while helping employees stay healthy has become a significant challenge. The mobile clinic has helped McRae with both goals, said Kay Martin, consultant and former vice president of human resources at the Montgomery County-based company.

“If we can prevent one heart attack by the care that this person continues to receive for their blood pressure, if we can promote wellness and identify the primary cause that might develop into a high dollar claim, then we have been successful,” she said.

A health and cost challenge

McRae’s challenge is more acute than most. Similar to other rural populations, many workers there have diabetes, high blood pressure and other chronic diseases. If left unchecked, these conditions can be costly to treat.

The average cost of diabetes care per person, including emergency department visits and medications, is just under $10,000 a year. The average cost of care for heart failure is more than double that.

A closeup of a hand getting blood sugar checked. — Berry Harris, a maintenance employee at McRae Industries gets his blood sugar checked at the FirstHealth mobile van. Also in the photo is Vicky Doby, a licensed practical nurse at FirstHealth. Photo credit: Liora Engel-Smith

McRae is self-insured, which means that the company is the financial backer of any health insurance they offer and needs to retain enough reserve to cover expensive diagnoses. The bootmaker must also pay a portion of every doctor’s visit, every medication and every emergency department visit employees incur, after copay and deductibles, Martin said.

Those costs can add up fast.

At the same time, the company found, employees were reluctant to go for basic medical care for any ailments because it meant taking off a few hours or even a half a day from work to keep doctors’ appointments.

Instead, maintenance worker Berry Harris visits the mobile clinic every few weeks to monitor his Type 2 diabetes. The 61-year-old gets his blood sugar checked and his prescriptions at the clinic. Since the clinic is free, Harris saves roughly $20 a visit by seeking his care here. He estimates that alone amounts to several hundred dollars a year.

“It’s free and they give you the same thing, so why not?” he said.

His health has improved, too. He’s lost three pounds since his last visit and he’s watching his carbohydrate intake, though he still eats sweet potato fries every once in a while, he said.

A supplement, not substitute

On an average day, physician assistant Darrin Cutrell sees several patients like Harris, either at McRae or other Montgomery County companies he works with.

Every so often, he encounters a real emergency that he alone can’t treat. In his three years of working with McRae, he’s diagnosed his share of prostate and breast cancers, but one day, a patient walked into the clinic with complaints of indigestion. That worker turned out to be in the middle of a heart attack that required emergency bypass surgery, Cutrell said.

And though Cutrell can draw blood and write prescriptions, employees still need their health insurance to pay for medications, specialist appointments and screenings such as mammograms.

While most employees at McRae are insured, Cutrell has worked with a few patients who aren’t. Even with cheap prescription drugs and the range of tests he can do in the mobile clinic, Cutrell’s services can’t totally address the health needs of workers. That’s not uncommon for workplace wellness clinics, said Larry Boress, executive director of the National Association of Worksite Health Centers, a membership organization based in Dallas, Texas.

A man in a hat is getting his blood pressure checked — Berry Harris, a maintenance employee at McRae Industries gets his blood pressure checked at the FirstHealth mobile van. Also in the photo is Vicky Doby, a licensed practical nurse at FirstHealth. Photo credit: Liora Engel-Smith

“People still have to get therapy, hospital care and specialty care and centers can’t offer these services,” he said. “ … the [workplace health] center can’t be another fragmentation of the health care system. It has to be incorporated into the system. That’s the only way you’re going to get quality care.”

Cutrell can, however, help workers manage chronic conditions such as diabetes and blood pressure at no additional cost to them. He can also see patients who suspect they have coronavirus via telehealth. Because McRae pays a flat fee for the service, Cutrell can check in with workers as often they need it.

And because people are at work, it’s easier to find and follow up with those workers.

“I can see them as many times as I need to to drive home the message, or make sure their medication is working and that they’re doing well.”

Barbara Pemberton, who works at McRae’s human resources department, has used the service many times over the last three years. The 57-year-old said the option is so convenient that she sees Cutrell for all of her primary care needs. Lately, she said, she’s needed help managing her blood pressure.

“It’s right here, and if I have a problem, it’s easy to come in,” she said.

A growing service

Workplace wellness services aren’t new, but their popularity is growing among larger employers, Boress, from the worksite health center association, said. The association estimates that roughly half of workplaces with more than 5,000 employees have some form of wellness services at the workplace, though the exact number is unknown because these centers do not need a license to operate.

A nurse in blue and black scrubs uses an ear thermometer on a blonde woman. — Debbie Saunders, an employee at McRae Industries in Montgomery County, visits the FirstHealth mobile clinic. Also in the photo is Vicky Doby, a licensed practical nurse at FirstHealth. Photo credit: Liora Engel-Smith

Companies also vary in the array of services they offer at their centers. Some employers offer free or reduced-price dental care, for example, while others focus on primary care or health screenings. Some bill insurance companies for services, while others do not.

Soaring health care costs and the desire to keep employees healthy and productive are driving the trend, Boress said. The wide variation in these clinics makes it difficult to evaluate the potential for cost saving on a larger scale.

FirstHealth’s model, however, is working, Cutrell said. The company serves five employers across Montgomery County and the health network is looking to expand its workplace services to neighboring counties, including Randolph and Lee, although the pandemic has slowed that process down.

Martin, of McRae, said the company plans to continue with FirstHealth, though the service has not entirely addressed every employee’s health needs.

“It’s a problem that continues to evolve with our people’s health,” she said. “But so far, I definitely think [the mobile clinic] impacted so many people’s lives in a positive way.”

man in fatigues and a face mask stands in front of a sign reading: "patient intake" in a COVID-19 overflow centr

Shuttered hospital could get new life courtesy of COVID

May 18, 2020 by Rose Hoban

Shuttered hospital could get new life courtesy of COVID - North Carolina Health News

Rural Sandhills facility repurposed for non-coronavirus patients in the event of a surge.

By Rose Hoban

The coronavirus pandemic has taken a toll on hospitals. Most hospitals lost millions in revenue when they stopped performing elective surgeries in mid-March, then spent millions gathering supplies and training staff to be ready for a potential surge in cases.

But the pandemic may have the opposite effect on one shuttered rural North Carolina hospital. Sandhills Regional Medical Center, located in the Richmond County town of Hamlet, which has had new life breathed into it as a result of COVID-19.

In April, the state contracted with FirstHealth of the Carolinas to rent the facility, which has been standing mostly empty since it closed almost three years ago. In the weeks since, vacant rooms have gotten a thorough cleaning. Personnel from some of North Carolina’s eight State Medical Assistance Teams, along with Army and Air Force National Guard members and the Department of Health and Human Services have brought in beds, equipment and supplies in anticipation of a surge of patients filling North Carolina hospitals.

The idea was to ease pressure on North Carolina’s health care system by creating a space for up to 70 “regular” patients who might need care but who could not be housed at a hospital caring for a surge of patients suffering the effects of COVID-19.

“It’s a geographical anomaly because it’s two hours from everything,” said Commander Sergeant Major Brian Webb from the Army National Guard, one of the leaders getting the hospital ready.

“It could be anywhere from a long-term health care facility that someone, something happened they had to be transported to the hospital, non-COVID obviously and they’re better,” Webb said. “Maybe there’s an outbreak in their (nursing home). They come here to get that care they still need before they can go back.”

Or the space could be used for someone who is no longer in need of ICU care, but who still needs a few days at a hospital before heading home.

“This is not a long-term facility,” Webb said.

Reuse, recycle

“There’s been about 130 closures in the 2000s of rural hospitals,” said Mark Holmes, who studies rural hospital closures at the Sheps Center for Health Services Research at UNC Chapel Hill. “Roughly about half of them get repurposed for something in health care, whether that’s an urgent care clinic or an after-hours clinic, or specialty care, primary care, something like that.”

Holmes said some old rural hospitals, which tend to be smaller, have become nursing homes or other types of long-term care facilities. That’s what happened to a hospital in Blowing Rock, which closed in 2013.

State Medical Assistance Team

North Carolina has a network of hospitals, health care providers and state assets organized to respond in the event of a medical disaster, such as an outbreak, or natural disaster, such as a hurricane.

The state maintains equipment, everything from first responder kits to a portable hospital in an 18-wheeler trailer that can easily be mobilized stored in warehouses around the state ready to be deployed.

SMATs also include personnel who can be deployed for shorter or longer periods, to staff these emergency medical facilities. These teams are organized by eight Regional Advisory Committees, Each county and hospital in North Carolina is included in at least one of these eight teams.

Other old facilities have more unconventional uses.

“They might be used by the local community college or one became a carwash,” Holmes said. “A couple have been converted to condos and one became a church. So, a wide variety depending on where it is and the state of the building.”

North Carolina has had 11 rural hospital closures since 2006. At 64 beds, Sandhills Regional was one of the largest of the facilities to be mothballed.

Since the closure in 2017, part of the facility has been used as a skills training site for the local community college.

Mostly new

North Carolina has had a need for temporary medical facilities frequently in recent years. During Hurricane Matthew in 2017, the Department of Health and Human Services stood up a shelter to house medically vulnerable people evacuated from areas of the state flooded by the record rainfall.

State officials repeated that feat during Hurricane Florence in 2018, creating four such medical shelters. One of those was in C3, a megachurch in Johnston County that converted a clean, roomy gymnasium, auditorium and child care spaces into temporary medical facilities. The state also created a medical shelter in older, more dilapidated buildings at the old Cherry Hospital in Goldsboro, a move that drew some criticism because of the state of the physical plant.

woman sits at a nurses station looking at a laptop. She's wearing a mask to prevent transmission of COVID-19 — Captain Danielle Fowler, RN with the Air Force National Guard keeps watch over a nurses’ station in the old Sandhills Regional Medical Center. Photo credit: Rose Hoban

The building at Sandhills Regional provides a welcome alternative to creating a medical facility from scratch. The hospital, built only in 2005, is roomy and has space to easily move around medical equipment. Each individual patient room has a functioning sink, FirstHealth has been maintaining the HVAC system, and there are even medical gasses, such as oxygen, available through ports in the wall.

“Having something that was ready to go, equipment in place, you know, within a day or two, turn it on and go would be a huge advantage,” said Department of Public Safety spokesman Keith Acree.

Another advantage in the age of COVID is that the rooms at Sandhills are separate, rather than housing people in one large space which could facilitate transmission of pathogens.

Acree, Webb and others were careful to say, though, that Sandhills would not be used for COVID patients.

“The center will not be used as a homeless shelter or care center for infectious disease patients,” FirstHealth spokeswoman Gretchen Kelly told NC Health News in April.

Hospital is dormant but at the ready

Walking through the hospital is a little bit like walking back in time to late 2017. A flyer posted in the elevator advertises a blood pressure screening event to be held in October of that year. On the whiteboard in the old intensive care unit are handwritten notes of what phone extensions needed to reach the X-ray and lab departments, departments that no longer exist unreachable by a defunct phone system.

There’s even “hospital art” remaining on the walls – nondescript landscapes in mostly pastel colors.

The hallways are wide and well-lit, patient rooms have plenty of space, and are now kitted out with hospital beds that are a step up from the medical cots used in hurricane shelters.

Another step up – the old gift shop has been turned into a temporary USO canteen to provide Starbucks coffee and snacks to the 70-some National Guard members who’ve been deployed there.

Several of the National Guard leaders who were veterans of the hurricane relief efforts said this was a definite improvement.

two people in fatigues use a infrared thermometer to check the temperature of a third person outside a set of doors into a COVID surge facility — National Guard members check the temperature and ask COVID-19 screening questions of anyone entering the temporary overflow facility at the Sandhills Regional Medical Center. Photo credit: Rose Hoban

But for now, Sandhills isn’t needed. Efforts around the state to “flatten the curve” of COVID-19 infections have reduced the patient load on hospitals to the point where it’s manageable. Acree said the state has a lease at Sandhills through July, paying $240,000 to lease 80,000-square-feet of the building. Then the state has the option to continue renting on a month-to-month basis until next year.

As of Sunday, the facility will be “dormant” but will be ready for use within a couple of days, now that it’s set up and ready to go, perhaps even in the case of a hurricane.

We see a scene from The Lost Colony, which will not perform this summer due to coronavirus

Coronavirus Today – April 7 – Grocery store crowd control, childcare funds for health workers, old hospital to be repurposed

April 7, 2020 by Editor

Coronavirus Today – April 7 – Grocery store crowd control, childcare funds for health workers, old hospital to be repurposed - North Carolina Health News

As North Carolina's coronavirus case count increases, Gov. Cooper said he will place additional crowd-control restrictions on grocery stores and other retailers.

By North Carolina Health News staff

Grocery store changes on the way

Gov. Roy Cooper plans to issue an executive order later this week with more crowd-control specifics for grocery stores and other retailers to strengthen the impact of his statewide stay-at-home order.

One of the most common complaints that his administration has heard from across the state is that going to the store can be akin to entering a menacing labyrinth for people trying to adhere to social-distancing rules. Some people are not keeping their distance.

“We hear that being a problem,” Cooper said. “We don’t want people to be afraid to go to the grocery store, to the pharmacy to get essential items.”

Some stores across the state have taken voluntary steps to help shoppers and their employees to try to prevent any virus spread through people who might be asymptomatic.

Coronavirus by the numbers

According to DHHS’ data as of Tuesday morning:

46 people total in North Carolina have died of COVID-19.
3,221 have been diagnosed with the disease. Of those, 354 are currently in the hospital. (The hospitalization figure is a snapshot of people with COVID-19 at any given day and is not cumulative.)
More than 40,000 tests have been completed thus far, though not all labs report their negative results to the state, so the actual number of completed COVID-19 tests is likely higher.
Most of the cases (42 percent) were in people ages 25-49. While 20 percent of the positive diagnoses were in people ages 65 and older, seniors make up 80 percent of COVID-19 deaths in the state.
16 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
There are 3,197 ventilators in hospitals across the state, and 749 ventilators are in use, not just for COVID-19 cases but for patients with other reasons for being in the hospital.

They have started limiting the number of customers who can be inside and have employees at the door keeping count of how many are going in and the number of people exiting. Some locations have made their aisles one way so shoppers won’t meet coming and going from different directions. Many have put tape on the floor in check out lines six feet apart. Plexiglass also has been installed at many cashier stations to help protect employees.

“This is a positive step and we need to make that kind of thing more uniform and that’s what you can expect in an executive order, “ Cooper said.

“If you might have to stand in line a little while to be able to get into the store, it would discourage people from going just because they want something to do,” Cooper added. “We think this is an important signal to send as well, that wherever we are, we have to keep our physical distance, and the best thing you can do right now is to stay at home.” — Anne Blythe

Maybe May, maybe not

Cooper spoke to the media on Tuesday, the day after researchers from UNC-Chapel Hill, RTI International and Duke University released a forecast of a state-specific model showing that lifting stay-at-home restrictions at the end of April and going back to pre-COVID-19 business as usual would overwhelm the health care system.

The modelers found that with social-distancing restrictions similar to the ones in place now continued beyond April, the crush of people infected with COVID-19-related pneumonia would not be as high and the system should have enough bed space available for those needing care.

“Now I know many of you are wondering if this North Carolina model means that our stay-at-home order will continue into May,” Cooper said. “The answer is we just don’t know yet.”

Cooper stressed the importance of staying home in the weeks ahead and limiting exposure to the public for essential business and shopping needs only.

North Carolina will continue to look at the state-specific model, which, according to the researchers, will evolve as more data become available during the pandemic. Cooper said his team also will look at other models and examine what has happened in other states and countries. Public health experts and business leaders will be consulted during the weeks ahead, too.

“Every day, several times a day, we’re looking at whether our efforts and interventions are doing enough,” Cooper said.

Cooper stressed that in the weeks ahead as he and his team pore over model forecasts and track the impact of the pandemic, public safety and saving lives will be at the forefront of his decisions.

“We know that if our hospital system gets overwhelmed and too many people get sick and die, …not only is that a human tragedy, but it’s certainly a long-term problem for our economy,” Cooper said. “There are a lot of people now out of work because of the havoc that this virus has caused.

“They need to know that we’re going to be working night and day to make the very best decisions to help them through this time and then also get our economy working again.”

Cooper said many of the adjustments that employers and individuals have made since the first COVID-19 infection was reported in North Carolina on March 3 could lead to a new way of life since it could be next year before a vaccine is available.

“People are using video conferencing and phones,” Cooper said. “We’re finding different ways to operate and to be successful, and as we go forward we can use some of the things that we have learned during this time. When things can open back up more, we can do it the right way because we’ve got to know, this virus is going to be with us for a while, at least until there’s a vaccine, and so we have to be careful with how we interact with each other.” — Anne Blythe

shows a hospital framed by pine branches — Sandhills Regional Medical Center in 2010. Photo courtesy: Winona Gibson, Flickr Creative Commons

Old hospital to be repurposed for COVID-19 patients

In late 2017, the Sandhills Regional Medical Center in the Richmond County town of Hamlet shut its doors.

The hospital had been acquired less than a year before by FirstHealth of the Carolinas, a chain of small hospitals headquartered in Pinehurst. But because of lax volume and few procedures being done, the company closed the 49-bed facility, which has space for surgeries, diagnostic imaging and clinics.

At the time, the facility was only seeing a handful of patients each day, performing an average of two surgeries per week and fewer than seven imaging studies daily, FirstHealth CEO David J. Kilarski said.

“Maintaining a highly trained staff with such low volumes is not a sustainable situation, especially when the same services are offered a few miles away,” he said in a press release.

Now the facility will get another lease on life, as a location for treating recovering COVID patients, that’s according to state emergency operations director Mike Sprayberry who made the announcement at this afternoon’s daily press briefing.

“In the event hospitals across the state exceed their bed capacity, Sandhills Regional will be used to house their non-acute and non-COVID-19 patients,” texted system spokeswoman Gretchen Kelly.

Sprayberry said that the Council of State had approved the lease on Tuesday morning.

“It can now be prepared to provide additional beds to support hospital overflow,” he said.

According to Kelly, the proposed agreement says “the state would provide all staff, supplies and equipment. The center will not be used as a homeless shelter or care center for infectious disease patients.”

The move comes at the same time the governor is preparing an executive order that will ease restrictions on hospitals that will be released later this week.

The executive order “will help to waive some regulations to be able to free up bed space because right now some hospitals have limits on the amount of beds that they can have,” Gov. Roy Cooper told reporters during a daily coronavirus press briefing. “It also helps to free up regulations to be able to have more health care providers who would be able to go to battle in this fight against the virus.” – Rose Hoban

Creating living spaces for people at risk

At the most recent count available, North Carolina has about 9,300 homeless people living around the state, not including the thousands who may be doubled up with family or friends.

Many of those people are at risk of acquiring coronavirus from staying in overcrowded shelters or other congregate living situations where people are at close quarters.

The stay-at-home order signed by Gov. Roy Cooper last week exempted those people,

but as reported by NC Health News, those closures create issues in accessing basic needs, such as bathrooms, running water for hygiene, and food.

Now the state will be creating spaces for housing these people, according to state emergency director Mike Sprayberry.

Sprayberry told reporters during a briefing on Tuesday that North Carolina had received FEMA help for creating the housing, which will be in hotels and dormitories, “for a variety of people in different situations who need individual housing to help slow the spread of the virus.”

“This can include people who are exposed to, or test positive for COVID-19 who do not require hospitalization but need to be isolated,” Sprayberry said. “Also people who have been treated for COVID-19 and were released from the hospital. People needing social distancing as determined by public health officials because they were at high risk due to their age, medical condition, or living situation.”

He said that his division is opening a support center to help municipalities with setting up these “non-congregate housing options.” – Rose Hoban

Funds available for child care for critical workers

State health officials reiterated their pledge this week to help emergency and critical services workers find and pay for child care. Plus, child care providers working during the crisis are also eligible for bonuses from the state, according to a news release from the N.C. Department of Health and Human Services.

The state is offering financial assistance to families with income up to 300 percent of the federal poverty level ( $78,600 for a family of four) if they have no other viable options for child care. Parents who are essential workers, which include health care workers, can fill out a form here and call a hotline at 1-888-600-1685 that’s staffed by the N.C. Department of Health and Human Services to find open child care centers in their area.

The state will keep paying out child care subsidy payments for April and May to day cares regardless of whether those centers remain open in April and May. N.C. Pre-K programs will also continue to receive funding. Teachers in those programs are expected to offer remote learning and support to those children if their center is closed, according to the N.C. DHHS press release.

Gov. Roy Cooper and Mandy Cohen, secretary of the state Department of Health and Human Services, stressed the importance of child care for front-line workers at a news conference on Tuesday.

“While most of us are staying home, some North Carolinians are providing the essential services that we rely upon every day,” Cohen said. “It’s the truck drivers who are delivering food or medical supplies, our grocery store workers who are stocking shelves, our pharmacists filling prescriptions, our janitorial workers who are sanitizing essential workspaces, and of course our health care workers on the front lines taking care of those who are sick.

“The one thing they all have in common is they are parents or they’re the caregivers of young children: When they go to work they need a safe place for their children, where they’ll be cared for and nurtured.”

Cohen included child care workers among those essential to the pandemic attack plan who, outside these unprecedented times, do not always get the credit they deserve.

“In the best of times they are our unsung heroes, who care for, love and teach our children,” Cohen said. “They are literally brain builders, supporting children’s healthy development so they have a strong foundation for health and learning, and that’s in the best of times. As we face this pandemic, we know our early childhood workforce is a support system that allows our essential services to be there for all of us.” — Sarah Ovaska and Anne Blythe

99 counties and the Meck ain’t one

Unacceptable. That’s how state Sen. Natasha Marcus (D-Davidson) described a decision by the State Board of Education to allocate emergency coronavirus relief funding to every county in the state, except Mecklenburg.

On March 24, Gov. Roy Cooper set aside $50 million of COVID-19 relief money for schools. Half of the package was divided among counties based on the number of enrolled students. The state board voted to allocate the other half based on a “low-wealth” percentage that favored counties with smaller tax bases and fewer reserves.

The state Department of Public Instruction, or DPI, said the formula factored in a district’s ability to pay for COVID-19 expenses using local money, a calculation that left CMS out in the cold for funding beyond its headcount allotment.

Marcus and 13 other Mecklenburg state senators and representatives issued a joint statement criticizing the decision. “Mecklenburg County has the most COVID-19 cases in the state and has more high poverty students than any other school district in the state,” the statement read. “We … call for fair treatment of all children, including those living in poverty in Mecklenburg County.”

Despite being a former member of the CMS board, state board chair Eric Davis defended the decision to exclude CMS from this round of funding. “We realize this will disappoint some folks, but we strive to be fair,” Davis said. “We thought in this particular case, taking into consideration the individual counties’ ability to generate funds for their school district should be the primary criteria. We have difficult choices. But we’re striving to meet the needs of all.” -Melba Newsome

Lost Colony loses 2020 season to COVID-19

Roanoke Island Historical Association’s (RIHA) Board of Directors has canceled the 83rd season of Paul Green’s The Lost Colony, which is performed nightly in Manteo during summer months.

In an announcement made on The Lost Colony’s Facebook page, RIHA board chair Kevin Bradley said the organization did not want to risk the safety of the audience, cast or crew in calling for the cancellation, the first since 1944, during World War II.

“Several times throughout our storied history, the community has rallied around The Lost Colony. Whether it was to help repair storm damage as a result of hurricanes or devastation caused by fire – every time the local community has stepped up and helped the Colony recover,” Bradley said in a statement.

“We feel this is the appropriate time for The Lost Colony to take a step back and to return the favor and rally around the community that has done so much for us.

“These are difficult times and that creates an environment where difficult decisions are required. And this certainly was a difficult decision for our Board of Directors to make – but I believe the correct one in light of what our community is facing.” – Rose Hoban

Mental health moment: cuteness overload

The Oregon Zoo has a video of adorable baby goats meeting other animals, among dozens of other videos, including one of elephants having a “pool party.”

These videos are a perfect opportunity to take a break from the news and enjoy some squeal-producing critter antics. -Rose Hoban

image of a keyboard and programming on the screen to represent cybersecurity issues

Health Care Providers Battling Cyber Attackers

February 21, 2018 by Mark Tosczak

Health Care Providers Battling Cyber Attackers - North Carolina Health News

These days providers both large and small have to be on guard against IT attacks, which can be costly in terms of time, money and inconvenience.

By Mark Tosczak

On Oct. 8, 2017, a computer was stolen from a UNC dermatology practice in Burlington; on its hard drive were medical records for some 24,000 patients.

A few days later, Pinehurst-based FirstHealth of the Carolinas shut down many of its computer systems for two weeks as technicians battled a ransomware virus designed to lock people out of their computers.

In February, a Wilmington eye doctor and a Durham dental surgeon had their office computer systems attacked by malware.

Those are just some of the dozens of such instances where North Carolina health care providers have been attacked by cybercriminals, or patient records have gone missing.

Over the last five years, more than 385,000 patient records in North Carolina have been exposed in more than 40 cybersecurity incidents. While federal laws require attacks involving 500 or more patient records to be disclosed, smaller breaches and other types of cyber attacks aren’t always made public.

Health care IT experts say these incidents are part of a constant digital skirmish taking place across computer networks as criminals, terrorists, “hacktivists” and sometimes even foreign nations attempt to access patient records and employee information and, sometimes, even hack into medical devices.

When, not if

“If there is a trend, the bad guys are winning,” said Ernie Hood, a former health system CIO who’s now senior director, research for Advisory Board, a Washington, D.C.-based health care consultancy.

In North Carolina, organizations of every size and type have been attacked – hospitals and physician practices, government agencies, insurance companies and even non-health care businesses that deal with medical information.

Robin Lang, chief information officer at CaroMont Health in Gaston, says when she talks to her hospital’s board of directors about cybersecurity threats she uses the word “when,” not “if.”

“We’re secure right now,” Lang said, and then added quickly, “We don’t know what might be released from the government — here’s an exposure, a vulnerability.”

For Lang and her staff, and for her counterparts across the state, security is a constant preoccupation.

“This is not making widgets,” Lang says. “People’s lives depend on it. [Operating rooms] need to run, emergency rooms need to run.”

Jon Sternstein, a Raleigh based IT security consultant who works with health care companies, says the health care industry is behind other industries, such as financial services, that have been targeted by cybercriminals.

“[It’s] a little bit easier to infect health care organizations than some other organizations, such as financial organizations,” he said. “Only recently have health care organizations realized they were a target as well.”

Painful lesson

In early February, on a Sunday, Durham endodontist Dr. Linda Levin’s office computers were infected with malware that encrypted all her data, making it impossible for her to access patient records.

“We had to cancel patients for the day since we had to wait for our backups to restore our records,” she said in an email. “We lost a day of income, had to replace a computer, and we had to analyze all of our computers to remove corrupted software.”

Levin said in the wake of the incident her practice is changing how it stores some of its larger radiographic studies and is also hiring new IT consultants with more security expertise.

Levin was relatively lucky. She had backups and was able to recover almost all of her data except for a few patient X-rays.

‘Someone’s knocking’

Lang, at CaroMont, says she and her staff worry constantly about known and unknown threats. Health care providers must comply with a variety of regulations and legal obligations to protect patient medical records, private employee information and information related to banking, payroll and other services.

“All of these keep us up at night worrying about what’s next,” she says. “Someone’s knocking on the door all the time, trying to come in.”

Knocking on the door is a good metaphor. Attackers will often work to get their software running inside a hospital network, where it scans for vulnerable devices.

Hood, from the Advisory Board, said he’s heard of a couple of instances where attackers exploited medical devices running Windows XP, an older version of the operating system software. The attackers got malware onto the hospital network, where it scanned for potentially vulnerable devices attached to the network.

The malware detected medical devices running Windows XP and exploited a vulnerability in that operating system to load additional malware onto those devices. That software “unwrapped” more dangerous malware and used the medical devices as staging platforms to attack other systems.

Hospital IT officials, Hood said, had turned off the setting in their malware software that monitored for Windows XP vulnerabilities, because they didn’t realize they had any devices running the outdated software. Microsoft stopped supporting Windows XP in 2014. But it still runs on some medical devices.

Hood and others say that medical device manufacturers and the FDA are making efforts to secure medical devices, which are regarded as potential vulnerabilities in hospitals filled with more and more devices connected through computer networks.

In 2015, a security researcher announced he had discovered a way to hack drug infusion pumps that could allow an attacker to send a fatal dose of a drug to a patient. In 2016, European researchers announced they’d found ways to hack into cardioverter defibrillators — a type of pacemaker which gives a stopped heart a jolt to restart it.

Medical devices, as part of the “Internet of things,” are a high priority for cybersecurity specialists.

“We have been spending a lot of effort and focusing on what to do about these things,” said Ed Brown, director of technology at CaroMont. “We’re doing everything we can possibly do with those devices, short of taking them off the network … and in some cases were doing just that, we’re taking them off the network.”

Human factors

Besides technology, security experts say many problems can be prevented by better training and making health care workers more security conscious.

“I’d say the easiest avenue into any organization for an intruder is usually targeting your employees and sending them phishing emails,” said Sternstein, the Raleigh security consultant. “You have to educate people.”

But health care organizations are doing more than that. Increasingly, cybersecurity is becoming an issue hospital boards are watching. Providers are buying cybersecurity insurance, which can help offset some of the costs associated with attacks.

A 2017 study from IBM and Ponemon found that the average cost of a data breach for health care organizations was $380 per record — higher than any other industry. That means if an organization had 1,000 patient records exposed in a breach, it would cost $380,000 to respond — funds that could cover everything from technology costs to purchasing credit monitoring services for affected individuals.

Health care organizations are also dedicating funds and people to focus on security issues. Asheville-based Mission Health partnered with Montreat College to help educate future cybersecurity specialists. In 2016, for example, it gave the college $25,000 to help build a security operations center at the college where students can get experience.

Experts say that threats to health care cyber security will continue to be a major issue for the foreseeable future. That’s a particular challenge for small providers, which don’t have the staff or money that hospitals can muster.

“I would advise anyone to ask their IT people how their system is protected, how it is backed up and to where,” Levin, the endodontist, advised. “Ask them which security system they use and how often it scans and which kinds of threats it can intercept or block. I made assumptions that my IT folks had proper security and backups but I did not ask specific questions.

“I learned a hard lesson.”

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