Introduction: The healthcare industry has begun seeing a new hazard develop against them-the threat of cyberattack. Beginning in 2016, healthcare organizations in the United States have been targeted for malware attacks, a specific type of cyberattack. During malware incidents hackers can lock users out of their own network to gain access to information or to hold the organization for ransom. With the increase in medical technology and the need for access to this information to provide critical care, this type of incident has the potential to put patient lives and safety at risk. Methods: A content analysis was conducted to assess the trend of attacks on healthcare organizations. U.S. Healthcare IT News and Becker's Hospital Review were used to collect all publicly reported malware attacks against U.S. healthcare organizations between 2016 and 2017. A logic diagram was also developed to illustrate how hackers gain access to a healthcare network using malware. Results: There were 49 cases of malware attacks against U.S. HCOs identified. The attacks occurred across 27 states, and they took place during 18 out of 24 months. Six of the organizations reported paying ransom, whereas 43 organizations did not pay or did not report payment to the press. Impacts of these attacks range from network downtime to patient and staff records being breached. Discussion: Malware attacks have the potential to impact care delivery as well as the healthcare facility itself. Even though this study identified 49 malware attacks, we know this number is significantly higher based on data from HIMSS and the FBI. A reporting loophole exists in that hospitals are only required to report attacks in the case of breached protected health or financial data. For HCOs to fully understand the risk cyberthreats pose, it is important for attacks to become public information and for lessons learned to be shared. Future research reviewing identified attacks could help identify best practices for the healthcare industry to better prepare for cyberattacks.

Integrated communitywide health promotion campaigns designed to influence the public can also affect the perceptions of policy makers. Future research should examine this linkage and determine whether resource allocation and policy changes follow such interventions.

As states have embraced additional flexibility to change coverage of and payment for Medicaid services, they have also faced heightened expectations for delivering high-value care. Efforts to meet these new expectations have increased the need for rigorous, evidence-based policy, but states may face challenges finding the resources, capacity, and expertise to meet this need. By describing state-university partnerships in more than 20 states, this commentary describes innovative solutions for states that want to leverage their own data, build their analytic capacity, and create evidence-based policy. From an integrated web-based system to improve long-term care to evaluating the impact of permanent supportive housing placements on Medicaid utilization and spending, these state partnerships provide significant support to their state Medicaid programs. In 2017, these partnerships came together to create a distributed research network that supports multi-state analyses. The Medicaid Outcomes Distributed Research Network (MODRN) uses a common data model to examine Medicaid data across states, thereby increasing the analytic rigor of policy evaluations in Medicaid, and contributing to the development of a fully functioning Medicaid innovation laboratory.

No abstract