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Preventive medicine key, even for computer viruses

The recent outbreak of Internet viruses shows how heavily some doctors depend on computers and e-mail, and the importance of protecting those business tools.

By Tyler Chin, amednews staff. Sept. 15, 2003.

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Since mid-August, William C. Miller, MD, a solo internist in Cincinnati, has been deleting hundreds of e-mails flooding his inbox because of Sobig.F, one of several "worms" unknown writers of computer viruses unleash on the Internet daily.

"My computer was not infected, but I clearly was affected," Dr. Miller said. At the peak of the virus he received about 500 e-mails per day, five times the usual traffic. "It's easy enough to delete them; it's just a darn nuisance."

Thanks to up-to-date anti-virus software and other computer security practices, Dr. Miller escaped relatively unscathed. But other computer users worldwide weren't as fortunate, underscoring how crucial it is for physicians to take steps to keep viruses from bringing their computer networks -- and practices -- to a grinding halt, physicians and computer security experts say.

"Corporate America and this whole country rely heavily on e-mail, the Internet and computer networks," said Daniel Z. Sands, MD, MPH, an internist and clinical systems integration architect at Beth Israel Deaconess Medical Center in Boston. "It's important, obviously, that we use good, safe computing techniques."

The threat that hacker-created viruses pose will only grow worse. Even if you escaped damage from the trio of Internet worms that felled scores of computer networks worldwide last month -- Blaster, Nachi and Sobig.F -- you may not be safe. Another variant of Sobig.F was expected to strike after Sept. 10, the date the creator of Sobig.F set for the virus to time out. And, that new variant is hardly the only immediate threat computer users face, said Kevin Haley, group product manager for the security response team at Symantec Corp., an anti-virus software company that detects 600 to 700 new computer viruses monthly on the Internet.

Commercial anti-virus and firewall software thwarts most of those viruses. But a few will -- and do -- evade the products' safeguards.

From Aug. 19 to Sept. 2, Sobig.F infected about 1.9 million PCs worldwide, including 862,000 in the United States, according to the Web site of Trend Micro Inc., a Tokyo-based anti-virus software maker. Over a two- to three-week period ending Sept. 2, Nachi and Blaster infected about 70,000 and 64,000 PCs worldwide, respectively.

"We will get better at catching them, but there will always be people who will be working very hard at the same time to come up with new ways to defeat the security measures we come up with," Haley said.

Viruses are often hidden in e-mail attachments. They also can be hidden in spam, the unsolicited e-mail that makes up half of the daily Internet traffic, according to Brightmail, a San Francisco-based anti-spam software firm.

Know what you're opening

That is why Dr. Miller in Cincinnati is vigilant about protecting his computer network.

"Number one, I make it a point of not opening e-mail that looks like spam because some of these worms, viruses and whatnot infect computers just as soon as you open e-mail, not the attachment," Dr. Miller said. "The other thing is I don't ever open attachments unless I know exactly where it came from."

He also buys anti-virus software every two years, downloads new virus definitions weekly from the Web site of his anti-virus software vendor and downloads critical software security updates from Microsoft Corp.'s site every two weeks.

Daniel Griffin, MD, a solo internist in Fort Collins, Colo., takes similar precautions. But they weren't enough to keep Blaster from infecting one of his computers. After a warning popped up on his screen, he immediately called an information technology professional.

Luckily, Dr. Griffin got the warning, and help, early enough so that the rest of his computer network was spared. He suspects the virus infected his computer after he opened an e-mail attachment from a patient.

Although he experienced little problem from Blaster, two years ago, after a lapse in updating his anti-virus software, another infection forced him to shut down his network for several hours. That virus made copies of the Microsoft Excel spreadsheets containing his practice's financials and e-mailed it to everyone in his Microsoft Outlook address book, Dr. Griffin said.

Despite those experiences, he continues to communicate with patients via e-mail, saying the technology is reliable and it reduces the volume of telephone calls. In fact, some patients came to him specifically because, unlike their previous doctors, he is accessible via e-mail, Dr. Griffin said.

Viruses are a concern, he said, "and even more of an issue if you think about a practice like mine where we're completely computerized. But in my situation, if I went back and stopped using e-mail, I might be seeing one less patient a day, which as a week or a month goes by is easily enough to pay for the new anti-virus program or the information technology guy."

Another checkpoint

To make sure he doesn't miss important e-mail, he tells patients to call if they haven't received a response within 24 hours, Dr. Griffin said.

That's a habit Steven Arendt, MD, a family physician at Covington (Wash.) Primary Care, a seven-doctor practice owned by Valley Medical Center, appreciates.

"If you're going to use e-mail, viruses are just the reality of it," said Dr. Arendt, who chairs the AMA's e-Medicine Advisory Committee and e-mails patients. "That makes it even more important to set up the expectations with your patients ahead of time, as far as response time and limitations of e-mail."

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