Check yourself before your wreck yourself! A common-sense approach to data security in your veterinary hospital.

It is a day like any other in your veterinary practice. Clumsy puppies and hissy kitties are coming in for their vaccinations. Your associate is working hard in surgery. You can hear the chatter from the front desk team as they are taking calls and answering questions from clients as you are moving from exam room to exam room. Then there are some of the worst words spoken that can be heard in a veterinary hospital: “Um doctor, something is wrong with our computers…all of them.”

Interrogations ensue and not one person ever really knows “who done it” or “how it happened”. All that you know is that your team can no longer access your software or your most important files to help you serve your patients and clients. All of the PDF docs, Word docs, and photos have been locked down and encrypted. When you try to open any of them a message reads that you must pay $10,000.00 in bitcoin to get your files back and then it gives you payment instructions. What a great day! These types of viruses are called RANSOMWARE and they are a plague upon veterinary hospitals all over Texas and North America.

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Most of the time this invasion is done with subtlety through an email. The email appears to be from either a co-worker or someone who is likely to email the hospital. The subject line may read: “Please help me open this” or “Please look at this” or some other subtle but firm command to help with opening or looking at something. The unsuspecting user opens the attachment. It is an executable file (these end in .exe) and now every computer in your entire network is infected and every file is encrypted. You have a choice. Pay the ransom and hope they are kind enough to remove the encryptions…or…you tear down your entire network and start over. Oh and there is a third choice, all of your data was backed up and secure…your IT consultant shows up and has your hospital back up and running within a few hours. That last one represents the vast minority of practices who are hit by these techno bandits.

This is a nightmare that I have witnessed several animal hospitals suffer through over the last few months. I am writing this to save all who read it a great deal of heartache, downtime, and money. This is America and you are free to ignore my advice, but I suggest you do what I am about to tell you if you haven’t done so already.

STOP! Do not open email attachments without VERIFICATION

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Read the subject line. If the subject is not a common subject line that you see regularly, STOP. Do not open the email. Contact the person who is sending it in person (if possible). Delete it otherwise. I know many veterinary hospitals have a publicized email address for clients and vendors, this brings me to the next order of protection.

Overhaul and Change your email system…immediately.

Stop using any email addresses with your clinic’s domain name. Yeah I know you paid for it but your email addresses are not private if you did not select the privacy option when establishing your website and email hosting. Remove all email addresses from your web pages. These butthole hackers can also find your email addresses on your website and mimic it. So please, remove email addresses from your website pages. Now, you need to create two brand new email addresses. I suggest you only use Gmail because they have great filters.

  • Create an email address for client communication only. Give this out in your ON HOLD message, give it out on your business cards. DO NOT PUT IT OUT ON YOUR WEBSITE. Your website should be equipped with a “contact us form” that is filled out by the client and then it automatically emails to your client communication email address.
  • Create an email address for vendor communications only. Give this out to your lab services, your pharma suppliers, and other vendors you purchase services and products from.
  • Forbid the staff from utilizing any personal email and all social media other than these two email addresses on your hospital’s network.
  • Designate only 2 or 3 people on your team to handle emails and the practice social media pages.

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Backup Your Data

Veterinary hospitals are data heavy businesses and this is why they are targeted more often than other businesses by ransomware pirates. There are patient medical records, inventory records, accounting records, HR records, and diagnostic imaging records. Often, these software systems that operate these records exist on the same network and server. There are some hospitals who do a great job of backing EVERYTHING up. There are others who only backup the patient medical records but they do not backup anything else…these are the ones who suffer the most in these virus attacks.

These are applications you should use to backup your data:

For all PDF docs, Word Docs, Excel Docs, and Photos

Dropbox – my favorite

Carbonite

Google Drive – my least favorite

For all Diagnostic Imaging Records (.DCM .TIF .JPG .PNG)

All of your images for x-ray, ultrasound, CT and MRI should be archived offsite. These are critical medical records for your patients that you are required to keep by law. Dropbox and carbonite are not a wise option for diagnostic images because they do not allow you to retrieve and review them easily. The most effective backup of your medical images is with a DICOM PACS (picture archival communication system). The old school PACS were a server that was setup in your hospital and they would cost anywhere from $50k to $100k. The new PACS are now cloud based and they much more affordable. Usually these services are based on a flat monthly fee or a per exam stored fee.

My Favorite PACS:

VitalPACS.com (by VitalRads.com) yes…shameless plug for me.

AccuVue (by Radmedix.com)

Keystone (by Asteris.com)

For Patient Medical Records

There are many Veterinary Patient Management systems, each will have their own way to backup your records. Some older versions of systems like Avimark or Cornerstone will ask you to backup to a server tape or to a separate hard drive that you must execute and take home each night. The modern cloud based records systems connect you to a cloud server where your records are always protected and backed up two and three times. My favorite way to backup our patient records is via the cloud. It is automatic and yes it costs less, much less. None of us are responsible for backing up the system and taking a hard drive home each evening. The system backs up on its own and we have peace of mind.

My Favorite Cloud Based Patient Records:

www.ezyvet.com

www.evetpractice.com

www.vettersoftware.com

Accounting and HR Records

I believe that accounting and HR can be as complicated as patient management systems. They come in all shapes and sizes. I really like Quickbooks online for accounting. As far as HR is concerned, you can now hire a freelance HR consultant to help you with OSHA, State, and Federal employment compliance. Most of these folks will ask you to use their forms which are usually stored in Excel, PDF, and Word. These should be backed up on your Dropbox, Carbonite or Google Drive.

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Hire a professional IT consultant  – aka propeller head or computer nerd

If there is anything that you need to do, other than everything else I have written about…it is this. Please hire an IT Professional and keep him or her on retainer with your practice. Do not hire your technician’s husband or your associate’s cousin. Hire a real IT professional who has experience in working with law offices, health care clinics and other professional offices which are data heavy. A good IT consultant is often a quirky person and will demand that you do everything a certain way. Follow their instructions without argument, it could save your practice someday.

So, there you have it! You now know what it takes to protect yourself at a basic level from these a-hole ransomware invaders. There are some victims of this crime that have paid the ransom and luckily they got their data released back to them. There are others who paid and then nothing happened. They were double screwed. Do not take any chances with this serious threat. Act now to protect your hospital and your clients.

-RW

 

 

 

 

 

There Ain’t No Strings On Me! Wireless Digital Radiography in Veterinary Medicine

There are still many veterinarians today who do not have the benefit of digital radiography in their hospitals. The majority have indeed made the move into digital over the last 10 years but there remains a remnant of veterinarians who still use film. Most of these film users claim that they are waiting for the price of DR to come down. This excuse is preposterous in my opinion.

Veterinary Digital Radiography at Basic User Level (Tethered DR Panel + New X-ray Table):

Any veterinarian practicing small animal medicine exclusively can add a digital radiography system (and a brand-new x-ray table) to their hospital for a little less than $60.00 per day.

 

Total Equipment Cost (includes tax and freight)

$66,000.00 US

5 Year Equipment Loan with Interest at 6.0%

$1,276.00 US – Monthly Payment

X-ray Fee

$125.00 / 3 Views

Minimum Monthly Caseload (3 view studies)

11 Cases / Month – Break Even Point

If your veterinary hospital is open for business 7am to 6pm for 6 days each week this calculates into the DR system costing you $53.17 US, each day that you are open for business. Not bad!!!

 

New Technology: Wireless Digital Radiography for Veterinarians

Wireless DR technology is a perfect investment for all veterinarians. It works very well for those who work in zoos, wildlife preserves, and mixed animal veterinary hospitals. Typically, these “forgotten veterinarians” have been required to purchase at least two different flat panel systems (one portable and one stationery) if they wanted to truly be digital throughout all species. The other choices would include purchasing a CR unit (cassette based) or just buying digital for small animals and using film for everything else. These complicated scenarios, I am happy to report, no longer hold true.

Wireless digital radiography is market ready and a few hundred of these wireless systems have already been sold and installed. One portable wireless DR panel can now be used to take instant radiographs on horses, cattle, goats, sheep, dogs, cats, birds, reptiles and many more species. The first wireless DR panels were launched around 2011 or 2012, and they have vastly improved in design and reliability since then. The first generation of wireless panels had some trouble with interference from outside signals such as cell phones and electrical grids. An abbreviated battery life was another challenge with the first-generation wireless panels. The highly-paid propeller heads in Asia and Silicon Valley have eliminated most (if not virtually all) of the bugs from wireless technologies and this includes digital flat panels. Most buyers are now purchasing their second digital system and leaving technologies like Film, CR, and CCD in the past which is exactly where they belong. Wireless digital flat panels are no longer the future, they are here!

 

Advantages of Wireless vs. Tethered

NO MORE WIRES – Wireless panels do not need to be wired into and timed (synced) with x-ray tubes and generators. All wireless DR panels now have what is called Auto-Timing. The panel senses the x-ray photons and automatically opens to receive them to produce an image. Furthermore, if a veterinarian is seeing many equine or food animal patients, this unit will not have wires that have the potential to become tangled or in the way.

PORTABILITY – Unlike some of the tethered systems, wireless panels can be connected (paired) to both a laptop PC and a desktop acquisition stations. This makes the wireless digital solution much more compact and portable within a hospital and away from the hospital. Another advantage to this portability is intraoperative imaging in the surgery suite. Veterinarians who perform orthopedic surgeries can now bring the wireless panel into surgery, utilize a sterile panel sleeve, and snap radiographs to ensure the proper placement of hardware. Never again will a surgeon need to move the patient into radiology during surgery. Many surgeons are using CR in surgery, which means there is a delay in snapping the radiograph and then seeing it due to the digitizing process. A wireless DR panel produces an image almost instantly, no waiting.

IMAGE QUALITY – This is a draw at minimum but I still consider that an advantage. I would challenge any veterinarian or veterinary radiologist to determine whether a set of radiographic images were created from a wireless DR panel or a traditional tethered DR panel. The wireless DR panels produce high quality, diagnostically crisp images just like many of their tethered counterparts.       

Question: Which images came from Wireless DR panels?

 

Answer: Both of them were taken by a wireless DR panel. 

Disadvantages of Wireless vs. Tethered

PURCHASE PRICE – Wireless DR technology is indeed more expensive than the tethered DR systems. On the low end, we see a wireless system selling for about $60,000.00 US and the higher end they can cost up to $80,000.00 US. This may scare some of the film users but it is not as likely to scare those practitioners who are buying their second or third DR system.

CYCLE TIME – Some of the wireless systems will take a little longer to cycle and reset between shots versus the tethered systems. This slower cycle time seems to only be problematic with selenium based panels during an equine pre-purchase exam. Many equine veterinarians will push DR systems to their limit in cycle time when taking up to 40 images during a pre-purchase exam at a big event such as the Keenland Sale. However, a slower cycle time is really of no consequence when taking only a 3-5 views on a single patient.

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Making the Wireless DR Purchase

What does it take to remove the fear and anxiety from this purchase? Let’s start with simple math.

Scenario #1 – Purchasing a high-end wireless DR system with a laptop & desktop station

Equipment Cost (includes tax and freight)

$80,000.00 US

5 Year Equipment Loan with Interest at 6.0%

$1,550.00 US – Monthly Payment

X-ray Fee

$125.00 / 3 Views

Minimum Monthly Case Load (3 view studies)

13 Cases / Month – Break Even Point

$64.59 US per day of operation

Scenario #2 – Purchasing the lower-end wireless DR system with only a laptop station.

Equipment Cost (includes tax and freight)

$65,000.00 US

5 Year Equipment Loan with Interest at 6.0%

$1,260.00 US – Monthly Payment

X-ray Fee

$125.00 / 3 Views

Minimum Monthly Case Load (3 view studies)

10 Cases / Month – Break Even Point

$52.50 US per day of operation

Most 2 doctor hospitals will take 20-30 x-ray case studies per month with digital. With that said, there are some veterinarians who rely heavily on radiographic studies to get answers and there are others who do not use x-ray to its fullest potential. I plan to address this tale of two veterinarians in a future blog, so please stay tuned.

Purchasing a wireless DR system is not out of the realm of possibility simply because of the cost. If your hospital is already seeing over 10 patients each month through the x-ray suite and you are charging the proper fees, adding a wireless system is not a difficult decision.

Which of these are from a wireless DR system?

Answer: The one on the left, with the two screws in the hoof block. The one one the right is taken by a tethered DR system. 

Who Makes Them?

There are several wireless DR systems for sale in the veterinary market place today. I am pleased to report that those I have experience with are good systems hailing from good manufacturers who all have track records of sales and support dating back over 10 years.

I can only speak about these certain manufacturers so please understand I am leaving a few others off this list simply because I know very little about their systems.

Canon (multiple dealers in veterinary)

RadmediX (1 exclusive dealer in veterinary)

 

These manufacturers make a good wireless DR panel and they do a good job supporting their panels after the sale.

 Which of these are from a wireless DR system?

Answer: The one on the right is from a wireless DR system. 

Decision Time

Yes! You can own a wireless DR system and you won’t be finding yourself broke and living under a bridge! Be fearless and embrace this wonderful technology. I always say that veterinarians can get a nice bunch of “new friends” any time they begin wondering the trade shows and asking dealers about equipment. Please understand that not all equipment sales reps are used car salesmen…even though many act like it. Understand that the vast majority of these sales people know very little about the technical application of what they are selling. They are all highly trained to do one thing…getting you to sign their proposal. Please know that you do not have make your decision alone. I have many years of experience in buying, selling, and using imaging technology in veterinary hospitals. Contact me when you are ready and I will be your wingman. Please leave a comment and visit our website at www.vitalrads.com. I appreciate the fact that you took precious time from your day to read this blog.

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What’s Next?

In March, I will showcase computed tomography (CT) in the general vet practice. Heads up! CT units are being carpet bombed into general veterinary hospitals all over the USA. I will outline the technology and teach you what to look out for from vendors. Stay tuned.

-RW

Spes et fides sans peur!