Health Tech
Leadership: Doing it Right with Active Listening
Barbara Howard, President ,Total Child Health
Leadership: Doing it Right with Active Listening
“To be successful, focus on a need or problem that is within your area of expertise, that you understand, and supplement your abilities with experts with complementary skills,” says Dr. Barbara Howard, President, Total Child Health, Inc. (TCH). Dr. Howard and her husband, Dr. Raymond Sturner, shared the same vision and had similar backgrounds in Developmental-Behavioral Pediatrics. Their passions resulted in a powerful partnership for the company with its goals of facilitating evidence-based health and mental health care.
The Journey
“I, along with my husband/partner, saw the advent of the internet nearly 2 decades ago as presenting a possible solution to several of the problems we saw in health care,” says Dr. Howard. The CHADIS system (www.CHADIS.com) we created, by collecting patient entered data online using a variety of questionnaires before visits then linking results to clinician decision support, addressed the problems of clinicians having inadequate time, knowledge and tools for evidence-based care. Through this system patients have the chance to carefully consider their concerns in advance, and prioritize them before their in-person visit and view individualized patient education and resources in their CHADIS portal. “The most memorable event in this business journey so far was finding within our hard-earned CHADIS research data on toddlers a method for autism detection using machine learning that is 3 times more accurate for 18-month-olds than any existing screening method,” says Dr. Howard.
Challenges in the Pediatrics Industry
According to Dr. Howard, one of the biggest challenges in the healthcare industry today is the enormous time burden for clinicians and staff of documentation requirements to meet regulations. To address this, Dr. Howard created CHADIS that enables patients, through pre-visit data entry, to make it easier for the clinician to provide and document comprehensive care. Digital transformation has brought a change that puts administrators and insurers in charge of the system where data and “productivity” are valued more than the quality of care. “While the internet allows for instant availability of massive amounts of data, translating this to apply to individual patients will always best be done by trained clinicians yet optimal ways to facilitate the adoption of innovations are still not clear. That is why we designed CHADIS to bring innovations and summarized information right to clinicians for direct patient care while collecting the data needed to meet regulatory requirements and reducing the burden of documentation,” says Dr. Howard.
Listening is the Key
Active listening is one of the vital traits that make Dr. Howard a strategic leader. She makes it a priority to hear the points of view of the people in all parts of the company as well as of clients and use the information to optimize the effectiveness of their CHADIS system. As a product of hard work and persistence, the company has received around 19 million dollars from Small Business Innovation Research awards over the past 17 years. CHADIS is now used by over 135,000 patients per month in 44 states and 10 countries and has been profitable for the past 3 years.
Wrapping it up,
According to Dr. Howard, failures are inevitable when you are innovating. Progress towards solutions will have ups and downs therefore problem-solving should be the priority. “Fear can inhibit good problem solving and instead needs to be a signal to re-examine your ideas and plans rather than stop,” says Dr. Howard.
Top 50 Healthcare Technology CEOs Of 2020
Health Tech
Viruses: Biological versus Computer
By Mark Webb-Johnson, Chief Technology Officer of Network Box
During this time of the COVID-19 pandemic, those of us working with computer viruses continue to be amazed at the similarities between the techniques used by the medical community to fight SARS-CoV-2 (the virus that causes the COVID-19 disease) and the processes involved in our electronic anti-virus systems. Let’s look at some of these similarities, and see how computer anti-virus researchers help protect.
By Mark Webb-Johnson, Chief Technology Officer of Network Box
What is the Virus?
SARS-CoV-2 is an RNA virus. Essentially, a strand of information wrapped up in a protective shell and a mechanism to infect cells – information, envelope, infection mechanism.
By comparison, a computer virus consists of the payload, a carrier, and an exploit mechanism. For example, the payload would be the malicious code, the carrier an email message, and the exploit mechanism something to take advantage of a vulnerability in a particular mail client. Another example would be script downloaded from a web page, taking advantage of a web browser exploit.
Replication
The virus’s primary purpose is to replicate – to make copies of itself. SARS-CoV-2 does this by infecting cells (in the lungs, stomach, and other areas of the human body), then using the cell’s own mechanisms to make copies of its RNA and make new virus particles.
Computer viruses have the same primary purpose of replication. They want to infect as many hosts as possible. Once in a computer system, they make multiple copies of themselves and transmit out to new hosts. It is this self-replication capability that defines this as a virus.
Identification and Testing
The gold standard for identifying viruses is the whole genome sequence. This maps the full sequence of the chemical components of the RNA (made up adenine, uracil, guanine, and cytosine; abbreviated as A, U, G, and C), and results in a very long string of these four letters. That is excellent for precise identification, but not so good for testing. Due to mutations, what we know of as SARS-CoV-2 is actually a collection of hundreds of different strains of the same fundamental virus, each with their own slightly different sequences (more on this later).
To test for the virus, researchers instead concentrate on relatively small portions of the full sequence. This way, they can extract samples from a potentially infected human, amplify the RNA in the sample to obtain enough to test with, and then compare that against the portion of the full sequence. That is the RT-PCR test.
Computer virus researchers work similarly. The payload of the virus itself is a sequence of computer code that can be expressed in binary, or more commonly in hexadecimal notation. Computer viruses are often intentionally self-encrypted and randomized (we call these polymorphic viruses) to avoid whole sequence detection. Nowadays, these are by far the most common form of computer virus seen.
Researchers extract portions of the sequence that don’t change and use pattern matching techniques to detect those partial sequences in suspicious samples. We call these ‘signatures,’ and they can be effectively used to detect known viruses in suspicious samples.
Immune Response and Vaccination
The human immune system has a component known as the ‘adaptive’ immune system. The system works by identifying portions of viruses already in the body, and creating antigen-specific cells designed to identify, remember, and attack that specific antigen. These cells protect against future infections of the same virus and can survive in the body for some time (months, or years, typically). This is why after you’ve had the measles once, for example, you usually don’t get it again. Vaccinations work by purposely injecting the body with antigens that will generate such an adaptive immune response, to protect you from future specific infections.
Computer anti-virus systems store databases of signatures of known viruses. When your computer receives a new file, it can scan it, look for a match against those signatures, and take action if a match is found (quarantine, etc.). Such signature-based systems are the computer equivalent to the body’s adaptive immune system.
Innate Immune Response
Another component in the human immune system is known as ‘innate.’ This system can detect what is not ‘you’ (what is ‘foreign’) and attack the invader. It relies on the antigen’s chemical properties and doesn’t need to have previously seen that specific antigen.
For computer anti-virus, this is extremely hard to achieve well. The capability to detect and block previously unknown viruses is what differentiates good anti-virus systems from the poor. Various techniques are used, but mostly revolve around a) decoding the virus code to the rawest form, b) detecting suspicious encoding or exploit behavior, and c) using emulation or sandboxing techniques to see what the virus does when executed. Looking at behavior, rather than code sequences.
Mutations and the Future
RNA viruses such as SARS-CoV-2 are very poor at accurate replication, and sometimes the copies made are not perfect. Base pairs get flipped. Portions of the sequence are lost. Parts of other viruses are incorporated. Before long, you are dealing with bad copies of bad copies of a bad copy. It is like the story of a million monkeys with a million typewriters, eventually producing the works of William Shakespeare. Sometimes these viral mutations are beneficial to the virus, but most often not. Whatever the outcome, these mutations are the way the virus adapts to further its goal of replication.
Thankfully, we do not see the same with computer viruses. A computer virus can and does make perfect copies of itself, 100% of the time. Sure, we have self-encrypting polymorphic computer viruses, and randomizing fragments are often introduced, but the core code of the virus is not changed, and certainly not randomly. Perhaps in time, we will see this, but with today’s non-forgiving computer CPU architectures, it is unlikely to be a successful approach.
Of course, given enough monkeys and enough typewriters, anything is possible. Perhaps they can even improve on Shakespeare. Before that day comes, however, make sure you are prepared. Subscribe to a Managed Security Services Provider (MSSP) that can adapt, and protect you from cyber threats.
