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GAO Says DHS Still Facing FITARA Implementation Challenges

GAO Says DHS Still Facing FITARA Implementation Challenges

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Border Security Concerns Aren’t Limited to the South

Border Security Concerns Aren’t Limited to the South

The U.S. border with Canada stretches 5,525 miles from Maine to Alaska, nearly three times as long as the southern border with Mexico. But securing the southern border consumes more than eight times the resources.

That could change.

All indications suggest the southern border is gradually becoming more secure. But as tougher immigration policies, improved infrastructure and new technology produce the desired results, officials say, early indications suggest activity may be heating up on the northern border. As with any other economic problem, constricted demand in one place creates opportunity somewhere else. “If you’re going to have a decrease in people coming across the border, you’re going to see an increase” in activity elsewhere, says Kate Mills, formerly director of legislative affairs for U.S. Immigration and Customs Enforcement (ICE) and now with the Monument Policy Group. Asked later about the northern border, she noted: “There is already an increase in Mexicans travelling to Canada.” Her implication: Some of those individuals are probably seeking an easier way into the United States.

The 1,989-mile-long border with Mexico is manned by more than 17,000 agents, while the northern border is manned by only about 2,000 border patrol officers, according to U.S. Customs and Border Patrol (CBP) data.

Border security can resemble squeezing a balloon: Press on one end and it just pushes the air to the other. That’s why flexibility –in where CBP deploys forces as well as in which systems it employs in each location – is an increasingly important concern.

“Clearly the focus has been on the southern border, and appropriately so,” said Jay Ahern, a former CBP acting commissioner now with The Chertoff Group, a Washington, D.C., consulting firm. But the northern border has been largely taken for granted. Its great length, characterized by dense forest and the Great Lakes, poses significant challenges. “There has been a lack of resources put to the northern border.”

Manning on both borders has increased significantly since 9/11. The southern border expanded from about 9,000 to about 16,000 agents in that time, while the northern border patrol increased from about 600 to 2,000. Now, as Congress considers the president’s request to add 5,000 more officers, some are concerned that it should be left to CPB to decide where those forces should be deployed. In the past, Congress sought to set limits on how those resources were used.

It’s all part of a pattern in which people focus on the physical border and forget about the bigger picture. “Too often we focus on the border,” Ahern said on April 11 at the Border Security Expo in San Antonio. “We say: ‘Let’s build a bunch of fence, let’s hire a bunch of new agents for enforcement.’ But it has to be a really comprehensive plan.”

The plan requires coordination with foreign policy, across agencies – including with the State and Defense departments, strong border security controls and strong internal law enforcement – all with support from local jurisdictions and private employers – through programs like e-Verify, a system for proving eligibility to work.

CBP, Ahern said, “needs the flexibility to move resources to where the threat is.”

Along the southern border, CBP does that today, routinely shifting resources as the threat changes. Most recently, after strengthening the border in Arizona, attention has begun to shift to Texas’ Rio Grande Valley, which CBP now sees as its biggest current area of vulnerability.

Having the flexibility to quickly respond to changing threats is a critical piece of CBP’s strategy. The agency wants to invest in Relocatable Remote Video Surveillance Systems (R-RVSS), rather than permanent sites, because these trailer-mounted systems could be quickly hitched up to a truck and moved to where they can have the greatest effect. Fixed locations require site preparation, making them more expensive to install and complicated to move. CBP awarded the R-RVSS program to General Dynamics Information Technology (GDIT), of Fairfax, Va., under the Federal Aviation Administration Technical Support Services Contract (TSSC-4).

In a joint announcement April 11, GDIT and CBP said RVSS has achieved “Full Operating Capability” on the southern border, where GDIT built and installed fixed-location RVSS systems in Nogales, Douglas, Naco, Yuma, and Ajo, Arizona. Additional relocatable deployments are planned in McAllen and Laredo, Texas later this year.

CBP sought additional ideas for remote video surveillance in a January request for information. With both fixed and mobile RVSS systems already in place in the south, the agency plans to add them to sites along the northern border, including Buffalo, N.Y., and Detroit.

“Currently we use a variety of technologies” on the southern border, said Benjamin Huffman, chief of strategic planning and analysis for the U.S. Border Patrol. These include RVSS, mobile surveillance systems and in the most remote areas, long-range radar-equipped Integrated Fixed Towers, along with aerostats, manned and unmanned aircraft and unattended ground sensors.

“Relocatable surveillance is an important tool to have in our security system,” Huffman says. “As these walls go up, as we’ve seen historically, it will shift some traffic. So the relocatable pieces allow us to flex with the flow of that traffic.”

It’s all part of a strategy aimed at having full operational control of the border, in which the wall impedes breaches, technology provides situational awareness and people use that awareness to stop those unimpeded by physical barriers.

Technology underpins the entire strategy. “That technology piece is going to be key,” Huffman said.

Indeed, gathering the technology is only half the battle. Making sense of it – rapidly identifying the nature of a threat and dispatching an appropriate response – remains a work in progress. Along the whole stretch of the southern border, CBP is just one piece of a coordinated multi-agency effort including the Coast Guard, ICE and other agencies. Together, they collectively manage information gathering and interdiction activities in the air, on the ground and at sea.

As more sensors are added, the need to fuse and sort those inputs and turn raw data into actionable intelligence will become the next frontier in border security.

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Technology Is Border Patrol’s ‘Highest Need’

Technology Is Border Patrol’s ‘Highest Need’

Securing the U.S. border with Mexico is within reach – provided the government mounts a coordinated strategy focused on technology and people, rather than infrastructure alone, experts told Congress last week.

“There is not a one size fits all solution to border security,” David Aguilar, former deputy commissioner of U.S. Customs and Border Protection (CBP) told the Senate Homeland Security and Government Affairs Committee April 4. The border is complex and varied, changing with terrain, the seasons and the way in which it’s defended. Illegal cross-border activity ranging from drug smuggling to human trafficking ebbs and flows as the border patrol and criminal gangs engage in a continuous game of cat and mouse, each adapting every time a new tactic is introduced.

Technology, however, holds the key.

“Technology is going to be the highest need the border patrol has,” said Aguilar, now a Principal at Washington, D.C.-based security consultant Global Security and Innovative Strategies (GSIS). “It gives you situational awareness, it gives you intelligence and it gives you the capability to respond in an effective manner – and in a safe manner, as well.”

In urban areas, gangs move drugs through tunnels under the border wall or bundle their illicit cargo in packages. Outside of town in less crowded areas, they launch packages over walls with home-made cannon and catapults.

Lawmakers from both parties along with Department of Homeland Security (DHS) Secretary John Kelly concede a full-fledged border wall “from sea to shining sea” may not be needed. Some areas will need two or three rows of fencing; others need defoliation and roadbeds for patrols. But regardless of how much hard infrastructure is added, the border patrol needs the intelligence-gathering capacity of cameras and the deterrent value of bright lights and loudspeakers.

That’s where the Remote Video Surveillance Systems (RVSS) comes into the picture. RVSS is a proven concept already in use in Texas and Arizona, where it has played a key role in reducing trafficking and reducing casualties on the border.

Yuma County, Ariz., was once one of the most porous stretches along the border. Not anymore.

“In 2005-2006, Yuma County was the worst in the nation in regards to cross-border traffic and the criminal element that accompanies it,” said Leon Wilmot, sheriff of Yuma County, Ariz., in February testimony before the House Committee on Homeland Security. “Our officers were going out there if not weekly, monthly, to attend to victims who were left there to die. The combination of fencing, law enforcement, presence on the border and the technology with cameras and sensors – to be able to detect individuals crossing the desert – was all a contributing factor in reducing that criminal element and of individuals being victimized [through] rapes, robberies and homicides.”

“RVSS increases situational awareness and enhances officer safety through a number of factors,” according to a CBP spokesman. “First and foremost, it is a deterrence. Think of RVSS as a home which has an alarm and security camera system. That particular home is much less likely to be burglarized than one that doesn’t have those layers of security.”

The first RVSS systems were deployed along the northern and southern border between 1997 and 2005. Upgrades on the southern border were completed by General Dynamics Information Technology (GDIT) in 2016 and the agency announced in February it was seeking other upgrades and additional installations.

RVSS employs day and night cameras, loudspeakers and floodlights. In the most remote areas, motion and seismic detectors may be used to trigger alerts, the CBP spokesman said. “CBP is always looking for and testing new technology to combat the threats we face.”

Along the southwest border, CBP pilots the use of trailer-mounted RVSS towers that can be repositioned as needs change. Unlike legacy RVSS platforms, they don’t require construction, reducing cost and increasing flexibility. These relocatable systems are seen as a complement to conventional RVSS, rather than a replacement.

In a request for information published in January, CBP said it is “contemplating an expansion of the RVSS Upgrade Program throughout the entire [southwest] and northern border.” The solicitation states “the RVSS Upgrade program will provide day/night surveillance from stationary and re-locatable locations with dedicated power and command, control and communications capability managed remotely by operators. … [and] will additionally support vectoring of Border Patrol Agents (BPA) … for event resolution and provide continuous monitoring of encounters for BPA safety.” The number of these RVSS Upgrade systems will vary by geography and operational needs, and the agency anticipates upgrading control stations at every Border Patrol Station. RVSS Upgrade Subsystems will be mounted on existing RVSS infrastructure or on other new or existing towers, rooftops or other structures.

The technology works as a piece of a system, in which barriers and technology are used to raise not only the physical barriers to illegal border crossing, but also the psychological and logistical ones.

“Agents alone can’t stop every intrusion,” says Robert Gilbert, a former sector chief at CBP and now a senior program director for RVSS at systems integrator General Dynamics Information Technology (GDIT). “It’s the combination of physical barriers, advanced detection technology and manned patrols that raises the stakes for intruders, increasing the time and effort it takes to get across, and influencing their decisions. When the risks become great enough, fewer people will try to cross, and that means more agents will be available to take on those that remain. But it’s the technology that makes that equation possible.”

Aguilar agrees. “The purpose of the fence is to deter, to impede – to basically create more time and distance for the officers to be able to responsibly react and take action,” he said.

Adding officers is another critical piece of the strategy. DHS has announced plans to add 5,000 more border agents, but that could take years to accomplish. Rep. Bennie Thompson, D-Miss., the senior Democrat on the House Homeland Security Committee, noted in a February hearing that the CBP continues to struggle to keep the uniformed officers it has, let alone add new ones. The border patrol is short some 1,500 officers now, even before new positions are added. He sees increased use of surveillance technologies as the answer.

“If we can see somebody five, 10, 20 miles away, approaching an area, and if we have the ability to communicate with local law enforcement and [CBP agents on the ground], we could direct more assets to that area for interdiction,” he said.

At that same hearing, Steve McCraw, director of the Texas Department of Public Safety and a former FBI agent, told lawmakers that there is no doubt that the combination of technology and human focus can change the security equation along the border.

“We’ve seen over time that you can influence the amount of drugs coming in and the amount of illegal aliens coming in – there’s no question about it. It’s border control physics,” he said. Technology must be “stacked,” beginning with cameras and towers and continuing up through aircraft, he said.

But just having the technology is not enough, he added. It must be continually maintained and upgraded.

“We don’t need yesterday’s technology for tomorrow,” McCraw said. Some existing “sensors are archaic,” and government must look to the private sector – “the experts in developing technology and making it work” – to ensure the border patrol has the equipment it needs to get the job done.

Peter Howard

Peter Howard,
Senior Director at GDIT

From a situational awareness standpoint, Border Patrol agents cannot be everywhere all the time, said Peter Howard, senior director at GDIT. “Having the ability to remotely detect illicit activity and threats increases the efficiency of operations and helps make sure the right number of agents get the call for any given situation. That makes a difference. It increases safety and also confidence, and the combination makes everyone more effective.”

Ronald Colburn, consultant for Washington, D.C.-based security firm Command Group and former deputy chief of U.S. Customs and Border Patrol, said the risks along the border are not always fully appreciated. “The violence of the [Mexican drug] cartels makes ISIS look like amateurs,” he said.

But increasing personnel, infrastructure and technology works, he said. “Those are the things that slowed illegal criminal activity.”

What will it take for future improvements?

“The right mix, rapidly deployed,” Colburn said. “Without the tactical infrastructure, [the border] is too weak. Without the right number of agents, it is too weak. Without the right mix of technology it is too weak.” That technology has to be “integratable,” he added, and must be replaced and upgraded over time to remain effective. And it must be deployed in concert with the other two elements of the strategy.

“Without the tactical infrastructure, we will not have accomplished border security,” Colburn said. “With it, along with technology and manpower, I feel we will finally see that light at the end of the tunnel. We will finally secure the border – not just in stretches, but all of it.”

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Health data management trends to watch for in 2018

Health data management trends to watch for in 2018

Shot of two surgeons analyzing a patient’s medical scans during surgery

By Bill Siwicki
January 04, 2018

Informatics, data analytics, privacy and security, clinical documentation improvement and information governance are among the imperatives that will dominate data trends in 2018, according to the American Health Information Management Association.

Data Analytics
Demand for services and projects will increase in 2018, AHIMA predicts. Data analysts are expected to be busy helping providers participate in new payment models and find their way through new policy initiatives such as MACRA.

Informatics
Data experts will help to mitigate physician burnout with electronic health records by streamlining processes to capture data in EHRs, protect patient-generated data in mobile apps and develop interfaces and dashboards for telehealth services, AHIMA said.

Privacy & Security
While cybersecurity incidents will likely continue to make headlines in 2018, there are a number of policies related to data security to watch for this year, AHIMA said. These include the issuing of “minimum necessary” requirements, guidance around mental health information and data sharing as required by proposed rules of both the 21st Century Cures Act and the penalty sharing provision of the HITECH Act, experts said.

Clinical Documentation
Clinical documentation improvement specialists will also continue to be deeply involved with claims denials in 2018, helping to identify denials for coding and documentation that should be appealed as well as continue to expand to new and specialty areas of healthcare such as long-term care, home health, psychiatric units and rehab facilities that call for high-quality documentation, AHIMA predicted.

Information Governance
In the area of information governance, experts said enterprise-wide retention policies and data quality will continue to cause cybersecurity challenges for providers in 2018, demonstrating the strong need for IG programs to address them.

Government & Policy
Federal rules and regulations will also be worth paying close attention to this year. In addition to the 2018 budget, which will affect funding of the Office of the National Coordinator for Health IT and HHS’ Office for Civil Rights, the forthcoming definition of “information blocking” defined by the 21st Century Cures Act will be a major story to look for because of its impact on a large portion of EHR users, AHIMA said.
Four big issues impacting inpatient and outpatient coding in 2018 will be reimbursement, telemedicine, copy/paste and coding auditing, the experts added. Also, starting in January, the Medicare Access and CHIP Reauthorization Act of 2015 will require physicians to start reporting patient relationship modifiers.

Workforce
Finally, with regard to education and workforce issues, “upskilling” existing practitioners for more advanced roles in data analytics and informatics, preparing academic faculty to teach higher-level content in data analytics and revising curriculums to ensure students are prepared to meet workplace needs are all education and workplace trends to pay attention to in 2018, according to AHIMA.

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HHS seeks a single framework solution

HHS seeks a single framework solution

An attractive senior black man uses his smartphone on the trail

By Jessie Bur
January 9, 2018

The healthcare industry operates with many incompatible networks, so the Department of Health and Human Services has taken a major step on its quest to forge a framework to bind them together. HHS on Jan. 5 released for public comment its draft Trusted Exchange Framework, which proposes policies and standards to promote the interoperability of health data systems.

“The draft Trusted Exchange Framework we issued today reflects the successes and challenges already existing in the exchange of health information and is designed to help guide the nation on its path to interoperability for all,” said Don Rucker, M.D., national coordinator for health information technology.

“The principles and direction we released today, combined with the support of providers, existing health information networks, health IT developers, and federal agencies, are designed to help improve patient care, care coordination, and the overall health of the nation.”
The framework was mandated by the 21st Century Cures Act, which became law in December 2016.

  • According to HHS, health organizations currently have to subscribe to multiple data exchange networks, which drives up costs and has issues with scalability. A single interoperability framework would help ensure that different networks can communicate with each other.
    The framework operates on six principles:
  • Standardization – adhere to industry and government standards
  • Transparency – conduct the exchange in an open and transparent manner.
  • Cooperation and non-discrimination – work with others in the industry, even if they are a direct competitor.
  • Security and patient safety – ensure data security and integrity throughout.
  • Access – ensure that patients and caregivers have access to health data.
  • Data-driven accountability – Exchange multiple records at one time to enable identification and trending of data to lower the cost of care and improve the health of the population.

According to the HHS press release, the final framework will support the goals of allowing patients to access their own information, health providers and others to receive population-level health data to better understand trends in that data and innovators to create new programs for increased usability.

Once the framework is finalized, HHS’ Office of the National Coordinator will select a Recognized Coordinating Entity to develop a common agreement that qualified health networks and their participants can voluntarily agree to adopt.
ONC will also be working with other health-related federal partners, including Veterans Affairs, to establish the best standards for the framework.

“The Department of Veterans Affairs supports ONC’s efforts to create a common ‘on-ramp’ to health information networks that supports widespread interoperability, said Dr. Carolyn Clancy, VA executive in charge. “We look forward to working with all stakeholders to ensure that our veterans’ health information flows and is available when and where it is needed to support seamless care.”
“We know that many stakeholders, including healthcare providers, health systems, developers, and existing health information networks have extensive experience in trust agreements and common exchange networks and strongly encourage stakeholders to share that insight with us,” said Rucker.

The comment period for the framework closes on Feb. 18, 2018, and comments can be submitted to [email protected]

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Study: Cybercriminals eyeing smaller providers and Health IoT in 2018

Study: Cybercriminals eyeing smaller providers and Health IoT in 2018

Cropped shot of an unidentifiable hacker cracking a computer code in the dark

By Bill Siwicki
January 5, 2018

This past year was another challenging one for healthcare organizations as they remained under sustained attack by cybercriminals who continue to target healthcare networks through the use of well-known vulnerabilities.

A new study predicts that 2018 won’t be any easier, especially as attackers increasingly set their sights on smaller providers and the myriad connected Internet of Things devices across healthcare.

In 2017, there were a total of 140 hacking-related data breaches reported to the Department of Health and Human Services’ Office of Civil Rights – a 24 percent increase over the 113 such events reported in 2016, according to the “2017 Health Care Cyber Research Report,” from cybersecurity vendor Cryptonite.

The number of reported hacking events attributed to ransomware by healthcare organizations jumped by 89 percent from 2016 to 2017, the study shows. This was an increase from 19 reported events in 2016 to a total of 36 events in 2017.

In 2017, ransomware events represented 25 percent of all events reported to HHS/OCR and attributed to IT/hacking. All six of the largest hacking-related healthcare events reported in 2017 were attributed to ransomware, the study found.

Somewhat encouragingly, this past year, just 3,442,748 records were reported to be compromised, a big decrease from 13,425,263 reported compromised in 2016.

But in years past, cybercriminals devoted significant time and effort to targeting the largest healthcare organizations. For example, 2015 breach events included Anthem (78.8 million records) and Premera Blue Cross (11 million records), and 2016 events included Banner Health (3.6 million records) and Newkirk Products (3.4 million records).

Now this low-hanging fruit has to some extent been harvested, and attackers are increasingly turning their attention to a broader mix of healthcare entities, the report said.

“The emergence and refinement of advanced ransomware tools lowers both the cost and the time for cyberattackers to target smaller healthcare institutions – now they can cost effectively reach physician practices, surgical centers, diagnostic laboratories, MRI/CT scan centers, and many other smaller yet critical healthcare institutions,” according to Cryptonite. “This is the beginning of a trend that will increase very substantially in 2018 and 2019.”

Internet of Things devices in healthcare also represent new and expanding opportunities for cyberattackers. IoT devices now are now nearly ubiquitous in healthcare – already widely deployed in intensive care facilities, operating rooms and patient care networks, said Michael Simon, president and CEO of Cryptonite.

“Cyberattackers target healthcare networks for two primary reasons – to steal the medical records they contain or to extort ransom payments,” said Simon. “Medical records are the targets of choice, as this data is highly prized to support identity theft and financial fraud. While 2017 was the year of ransomware, we are anticipating this already hard-hit sector will feel the wrath of cybercriminals targeting the hundreds of thousands of IoT devices already deployed in healthcare.”

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