Computer viruses and palliatives against them are a growing threat to high-tech care. There is a classic solution for the old problem of a vulnerable mono-culture: diversity.
Last Monday alarm bells went off in many IT departments. A viral infection on Windows XP computers was initially caused by an anti-virus update from McAfee. The update made part of the system appear to be a threat and system file protection software made the system unusable, a type of auto-immune disease.
In hospitals and care institutions XP is still widely used, as specialised medical applications are often not ready for the new Windows version (and as often purely because of under-investment). This time it was McAfee, but almost all anti-virus products from time to time cause such problems. Anti-virus updates are a real-time arms race and sometimes in the rush things goes wrong.
From agriculture and ecology, we know that monocultures are efficient but also very vulnerable. It is no different in the pig pen of IT. The management of 4500 identical systems seems simpler than a more varied infrastructure – until a virus or autoimmune disease outbreak. Then the overtime starts. The scale of many of these incidents shows that even large health care institutions do not have proper internal firewalling and compartmentalisation. Nevertheless, the situation is better than five years ago.
Security issues caused by monocultures are not a new story. In 2003 Daniel Greer and Bruce Schneier wrote a report about the security implications of the dominant OS monopoly. Since that time neither the market nor the government has succeeded in effectively breaking this monopoly. In health care applications with medical or laboratory equipment included, many are Windows-only. Vendors often set additional conditions on the PCs, for example no firewall, before guaranteeing proper functionality for of their own applications. Thus a computer virus (or an autoimmune disease) is not only annoying for the admin department, but can also make scanners unusable. The MRI scanner can still take images, but the PC is crucial to the operation and viewing the results. So a Philips or Siemens unit worth a cool million is effectively scrap metal and patients cannot be treated. Sooner or later, this is a real time problem and then way more people than just the help desk are affected. In England, more than 1100 National Health Service computers were infected with a data-thieving worm. And there goes your medical confidentiality.
From the many conversations I have had in recent years with IT workers, I conclude that the difference between a product monoculture (a 'standard' desktop) and the application of standards to achieve interoperability is still not understood. Some years ago I spoke to a ministry official who enthusiastically told me that a 'standard' desktop was going to be implemented for the entire government. When I asked what standards would be applied, he launched into a list of products, "this version of an OS, this version of a word processor" and so on. The perception is prevalent amongst many IT managers that systems can only work and be properly managed if they are all from the same vendor and version. But this is much more a symptom of market failures and the immaturity of the IT industry. It is a problem to be solved, not a law of nature to which we have to adapt.
That there is another way to do things can be seen from the work over the past 10 years in the Antonius Hospital in Nieuwegein. There they have consistently, in small steps, consciously worked to minimize dependence on a particular vendor, platform or application. What most IT managers of health institutions describe as 'impossible' has been done in Nieuwegein. Fortunately this hospital is in the centre of the Netherlands so when a really big crash occurs all critical patients can be sent there. In 2010 we can avoid succumbing to the first virus or software-update-gone-wrong by using virtualisation, web-enabling and open standards environments to build greater diversity and interoperability.