Is medicine’s greatest breakthrough also the world’s most efficient killing machine? After a decade of development, the cutting-edge Electronic Health Records system is about to become the national standard. Housing the real-time medical records of every American, the EHR system will enable doctors to access records with a keystroke and issue life-or-death medical orders with a finger swipe.
No one wants the EHR to succeed more than Hugh Torrence, a former NSA honcho who sees the system as a tool for unimaginable and unaccountable power. The only thing standing in his way is a loose-knit group of Drexel employees with conflicting agendas and questionable loyalties. While they search for answers, the suspicious patient deaths keep mounting…and the target on their back grows larger.
Read on for an interview with Marschall Runge, author of Coded to Kill.
Q. Where did the idea for Coded to Kill originate from?
A. Two words: aggravation and imagination. Like many physicians—I’m a cardiologist—I found the transition to electronic health records (EHRs) to be problematic because they increased our paperwork and diverted attention from patients. As a hospital administrator, I learned more about the power of EHRs—they do improve communication between healthcare providers and make previously illegible notes now legible. But there is little evidence that, overall, EHRs have reduced medical errors, which was their promise. And protected health information (PHI), which previously had to be obtained in written medical records, is now online and accessible both to all who have access to these records, as well as to nefarious characters cruising the internet for private information. With these ideas swirling in my mind, and having read too many thrillers, it occurred to me that a novel hinged on the promise and perils of emerging medical technologies would be a fun and effective way to share my concerns with the public.
Q. What are your thoughts on recent ransomware attacks on hospitals and how does this phenomenon relate to Coded to Kill?
A. Ransomware attacks—where hackers steal or take control of vital systems and information—are a growing threat to public safety and health. Hospitals are an especially attractive target because we must maintain highly detailed and organized information on those we care far and because our work truly involves life and death stakes. Though the potential risks of online medical records are heightened in Coded To Kill, it is important that everyone who uses EHRs and/or have their information contained in them understand their vulnerabilities. In Coded to Kill, the action of my “heroes” provide a realistic hope that we can fight back.
Q. How should the medical industry approach privacy concerns?
A. Hospitals have a sacred duty to safeguard Protected Health Information (PHI) even as we face challenges not just from malevolent hackers, but, ironically, from our own decision to improve patient care (and generate revenue). “Data aggregators” like Google offer tens of millions of dollars for access to large medical record databases and high quality information that can be used to devise new diagnostic tools and treatments. Coded To Kill illustrates a reality—that some of these arrangements become deals with the devil as “anonymous” patient records can, in some circumstances, be de-anonymized. I am proud to say that Michigan Medicine has become a leader in implementing programs to thoroughly evaluate and vet these requests.
Q. In the medical field, do the pros of technological advancements outweigh the cons? Is there a clear path for mitigating the negative effects of progress?
A. I am convinced that medicine is on the edge of a golden age of innovation that will deliver lifesaving and life-enhancing results to patients around the world. Technological advances are already resulting in amazing therapies and many diseases that were untreatable when I began my career four decades ago can now be cured. A major problem, which Coded To Kill illustrates, is that technology can also be hijacked by bad actors. These vast changes also create another problem: the opportunity of fraudsters such as Elizabeth Holmes and Theranos to exploit this hope to peddle high-tech versions of snake oil that hurt those who need help.
Q. In your opinion, does the future of medicine involve AI?
A. Absolutely. Generative AI and deep machine learning are already providing amazing advances in drug discovery, diagnosis and prevention. When I began my career, it took months or even years for advanced medicinal chemists to identify a small number of compounds they could modify and test to inhibit key disease pathways. Just within the last year, AI/ML algorithms have been developed that can generate more than one million new structures a day. But, like the advanced EHR featured in Coded To Kill, we never forget that machines are tools that must be used and controlled by human beings, who possess a conscience and morals. We are the secret sauce of innovation.
Q. What’s next for you?
A. My experience writing Coded To Kill has convinced me that novels provide a great opportunity to bring important medical issues to life—to start meaningful conversations with the people we care for. I am working on a second novel that revolves around an extraordinary investigator using AI to discover secrets that seem to reverse aging. But shortcuts were taken, data was faked, and terrible outcomes in an illicit clinical trial involving prisoners were suppressed…. you get the picture. As with Coded to Kill, I will use real-life examples as a starting place for each of these themes.
Purchase your copy of Coded to Kill here.
Marschall Runge, MD, PhD, is the executive vice president for Medical Affairs at the University of Michigan, dean of the Medical School, and CEO of Michigan Medicine. He earned his doctorate in molecular biology at Vanderbilt University and his medical degree from Johns Hopkins School of Medicine, where he also completed a residency in internal medicine. He was a cardiology fellow at the Massachusetts General Hospital. He is the author of over 250 publications and holds five patents for novel approaches to health care. As a Texas native who spent fifteen years in North Carolina and an avid thriller reader, Runge has experienced so many you-can’t-make-this-up events that his transition to fiction was inevitable.