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Cybersecurity Consultants Weigh In: Healthcare Organizations Shouldn’t Go It Alone

January 31, 2017
by Heather Landi
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Earlier this month, Austin, Tex.-based cybersecurity and privacy consulting firm CynergisTek announced it had been acquired by Auxilio, Inc., an IT security services provider based in Mission Viejo, California, in a deal valued at up to $34.3 million.

In addition to IT security services, Auxilio also provides document workflow solutions and services such as document consulting, print-as-a-service (PRaaS) and print device security. CynergisTek will continue to operate independently as a wholly owned subsidiary of Auxilio, and, as part of the deal, Auxilio’s Redspin division, which focuses on penetration testing and security assessment, will become part of CynergisTek. Following the acquisition news, it was announced this week that CynergisTek was ranked Best in KLAS in the Cyber Security Advisory Services category in the 2017 Best in KLAS Awards: Software & Services report.

Company co-founders Mac McMillan and Michael Mathews, Ph.D, launched CynergisTek in 2004 and in the past 13 years the data security landscape in healthcare has changed significantly. With the advancement of the Internet of Things (IoT) and connected medical devices, healthcare cybersecurity has only become more complex and challenging.

At the time of the acquisition announcement, McMillan said, “Our clients recognize that document and device security are important components of their overall security risk profile and the ability to deliver an integrated approach to managing those aspects of their infrastructure along with the digital pieces we’ve traditionally focused on is something we are laying the foundation for now.”

In a prepared statement, Auxilio CEO Joe Flynn said when announcing the acquisition, “We have come to know the founders and employees of CynergisTek quite well over the last couple of years and from the earliest conversations it was obvious we shared a vision of what the future of healthcare IT security and document workflow looked like and how the two will become increasingly intertwined.”


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Healthcare Informatics assistant editor Heather Landi recently spoke with both McMillan and Flynn about how the cybersecurity threat landscape in healthcare has changed and the ongoing challenges facing data security leaders at patient care organizations. Below are excerpts from that interview.

Both of your companies have experienced strong growth in the last few years. How might that reflect the current security landscape?

McMillan: There’s no doubt about it, bad news or good news, whichever way you look at it, the threat environment is not abating at all. It’s going to continue to create challenges for organizations or industries that are very reliant on their information system and their data, which healthcare is. And, it’s an area that, unfortunately, healthcare is still very much behind the power curve, so to speak, in terms of the level of investment that the industry has made compared to other regulated industries. So there’s a tremendous amount of running room left in the market for companies to grow that have the right model and right approaches and the right set of services. So far, knock on wood, we’ve been there and hopefully the Auxilio transaction is going to give us the ability to turn up the heat and continue to grow in that direction.

Mac McMillan

Flynn: The need for healthcare to operate more efficiently and to save dollars has been the focus of our model, however, over the last four or five years, security has been number one on the list of priorities for our IT clients, which prompted us to make investments in this area. Typically, our team reports in to the IT organizations, so wanted to have a good answer them as to how we were going to help them secure the document production side of things. That is absolutely a priority and I don’t see that priority going away anytime soon.

What are the biggest data security challenges facing healthcare CIOs and CISOs?

McMillan:  I think one of the biggest challenges they are dealing with is their shrinking budgets and trying to catch up with where they need to be on the security front. It’s becomingly increasingly difficult for them to find the dollars to invest in the spend for an area that is typically not viewed as producing revenue, but there is an absolute critical need for them to do that to protect the environment that actually is producing the revenue, so that’s a big challenge.

Another challenge is the absolute pace at which technology is evolving and innovating. They are deluged, with new applications, new systems, new devices and new approaches to handling data and sharing data, and at an exponential rate, and that in and of itself is creating tremendous challenges for them to try to keep up and to try to understand the risks associated with that. Right behind that is the fact that healthcare is absolutely a target today for cybercrime. Criminals have figured out how to monetize cybercrime and they have figured out how to push healthcare’s buttons with respect to the types of attacks that are effective and those three things create a very challenging landscape for a CIO.

Flynn: To echo Mac’s comments, we see a lot of concern about their ability to have the financial capacity to keep up with all the changes that are happening on the technology side--security as well as data and the applications that run on their network. And shrinking budgets means, a lot of times, shrinking staff as well, so that’s another big issue that healthcare is facing right now.

Joe Flynn

What are CIOs and CISOs at patient care organizations going to be focused on in 2017 regarding data security?

McMillan: I think they are going to be focused more on looking for efficiencies in their support structures. I think they’re going to be focused on outsourcing more of their security to trusted advisors and partners, and I think they are going to be looking for staffing support with respect to security. We have a number of clients that are coming to us now saying they can’t fill these positions, can’t find a good CISO and need support in that arena. They’re going to be focused on trying to make the right choices with respect to the technology that they invest in and deploy to meet their cybersecurity needs. So, I think it’s really going to be around trying to be as effective as possible with their dollars and figuring out what should I be doing and what should I have someone doing for me as part of a hybrid approach as doing it all in-house is not going to work going forward. Outsourcing everything is not necessarily comfortable for most organizations either. They’re really to try find that right hybrid balance between the right amount of external support with trusted partners and the right amount of internal activity.

Flynn: I agree with Mac 100 percent. We see the same thing and our model is very much a staffing model, in that, when we get a contract with a big health system, we put a number of people on site at the major facilities, and that is an absolute benefit because oftentimes because they are short on staff or the document management side of the house is not prepared enough to deal with the demand from the end users. So, staff augmentation in our world is very important and staff augmentation of people that have the skill sets to understand the clinical environments is even more important And, to echo Mac’s sentiment, these are times in healthcare right now where dollars are thin and, more importantly, staffing is thin.

In the time that you’ve been in the healthcare cybersecurity space, what are the biggest changes that you’ve seen?

McMillan: I think the biggest changes that have occurred most recently relate to the fact that the industry’s maturity level has risen to the level that they recognize that this is a very complicated part of their business. It’s not something that they can just assign a network guy to or the compliance guy who’s interested in security so we make him the security manager. They are recognizing that there is a level of expertise, experience and sophistication that they are going to have to throw at this problem and this is not something that they can or should go alone. So we’re seeing more and more of our hospitals ask us to take over certain functions, to provide services, to provide dedicated support. They really want security partners now. They want security vendors who provide services, and not just products and not just a project. The industry is changing and that’s probably the biggest change in the industry—they are embracing this partner model and outsourcing model as it relates to security and as opposed to trying to do it all in-house like they were before.

Flynn: We’ve only actively been in the security business since 2014, but the change that we’ve seen in our world is that security around devices that are on the network, which had previously been overlooked and it’s thousands of devices in the area of print, that wasn’t really a priority when we started this business and organizations never asked about it much. Over the last four or five years, it’s become a major priority. I think the IT leaders have recognized the vulnerability of the situation because of all these devices being on the network, and most of the devices are computers in and of themselves with a tremendous amount of PHI [protected health information] on them. So the threat level and the anxiety around securing these devices has become a big issue in the last four or five years.

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Healthcare’s “RegTech” Opportunity: Avoiding a 2008-Style Crisis

September 21, 2018
by Robert Lord, Industry Voice, Co-Founder and President of Protenus
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In the financial crisis of 2007 to 2009, the financial industry suffered a crisis of trust. A decade later, banks and other financial institutions are still working to regain the confidence of consumers and regulators alike. In 2008 and 2009, while working at one of the world’s top hedge funds, I had a front-row seat to the damage that occurred to our economy, watching as storied corporate institutions fell or were gravely damaged. Today, as co-founder of a health technology company, I see healthcare is approaching a similarly dangerous situation. We must get ahead of the curve to avoid disaster.

Like finance, healthcare is a highly-regulated industry where non-compliance can result in severe financial and reputational consequences for healthcare companies, and severe impact on people’s lives. We deal with HIPAA, MACRA, HITECH, and hundreds of other foreboding acronyms on a daily basis. A lot of attention goes to the terrific and important work of clinical decision support, wellness apps, and other patient care technologies, but problems in the back office of hospitals must be addressed as well. One of these problems is the amount and complexity of healthcare regulation, and our healthcare system’s inability to keep up.

In finance, where I spent the early part of my career, the adoption of what is termed “RegTech” (regulatory technology) was driven by the increasing complexity of financial technology and infrastructure sophistication.  As trades moved faster, and as algorithms, processes and organizations became more complex, the technologies needed to ensure regulatory compliance had to move in tandem.  The crisis we experienced in 2008 was partially the result of the inability of the industry’s regulatory capabilities to keep up with the pace of technological change.  In many ways, the industry is still playing a catch-up game.

As healthcare professionals, looking to the lessons learned by our colleagues in finance can help us predict patterns and stay ahead of the curve. Right now, I’m seeing alarming parallels to challenges faced in finance a decade ago.


How to Assess IT Risk in a Healthcare Environment

In this webinar, Community Health System’s CISO Scott Breece and Lockpath's Sam Abadir will discuss the unique IT landscape of the healthcare industry and the challenges this presents for IT risk...

Robert Lord

The burden of regulation across our industry is simply staggering.  Thirty-nine billion dollars of regulatory burden is associated with healthcare annually, which is about $1,200 per patient, per year. Despite this high cost, we still have $1 trillion of fraud, waste and abuse in our healthcare system. With so much regulation, why are we seeing so little yield from that burden? In many cases, it’s because we’re merely checking boxes and not addressing core risks؅. Like finance, there was a great deal of effort on compliance with regulations, but not enough attention on addressing important systemic risks.

This is not to say I am against good regulation; in fact, many regulations serve to protect patients and improve care. The problem is that there are so many demands on healthcare systems, that compliance and regulation is often reduced to checking boxes to ensure that minimum defensible processes are built, and occasionally spot-checking that things look reasonable. We currently have nowhere near 100 percent review of activities and transactions that are occurring in our health systems every day, though our patients deserve nothing less. However, unless overburdened and under-resourced healthcare providers and compliance professionals can achieve leverage and true risk reduction, we’ll never be able to sustainably bend our compliance cost curve.

Systemic problems are often not discovered until something goes horribly wrong (e.g., Wall Street every decade or so, the Anthem data breach, etc.). Today In the financial industry, RegTech provides continual, dynamic views of compliance or non-compliance and allows management, compliance professionals and regulators to check compliance in real-time. They can view every record, understand every detail, and automate investigations and processes that would otherwise go undetected or involve lengthy and labor-intensive reviews.

The real promise of these new capabilities is to allow compliance professionals and regulators to perform the truest form of their jobs, which is to keep patient data secure, ensuring the best treatment for patients, and creating sustainable financial models for healthcare delivery. RegTech will open up lines of communication and help create conversations that could never have been had before—conversations about what’s not just feasible for a person to do, but what’s right to do for the people whom regulation seeks to protect.

No longer bound by limited resources that lead to “box-checking,” compliance officers can use new and powerful tools to ensure that the data entrusted to them is protected. At the same time, healthcare management executives can be confident that the enterprises they manage will be well served by risk reducing technological innovation.  Patients, the ultimate beneficiaries of healthcare RegTech, deserve as much.

Robert Lord is the co-founder and president of Protenus, a compliance analytics platform that detects anomalous behavior in health systems.  He also serves as a Cybersecurity Policy Fellow at New America.


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HIPAA Settlements: Three Boston Hospitals Pay $1M in Fines for “Boston Trauma” Filming

September 20, 2018
by Heather Landi, Associate Editor
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Three Boston hospitals that allowed film crews to film an ABC documentary on premises have settled with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) over potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

According to OCR, the three hospitals—Boston Medical Center (BMC), Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH)—compromised the privacy of patients’ protected health information (PHI) by inviting film crews on premises to film "Save My Life: Boston Trauma," an ABC television network documentary series, without first obtaining authorization from patients.

OCR reached separate settlements with the three hospitals, and, collectively, the three entities paid OCR $999,000 to settle potential HIPAA violations due to the unauthorized disclosure of patients’ PHI.

“Patients in hospitals expect to encounter doctors and nurses when getting treatment, not film crews recording them at their most private and vulnerable moments,” Roger Severino, OCR director, said in a statement. “Hospitals must get authorization from patients before allowing strangers to have access to patients and their medical information.”

Of the total fines, BMC paid OCR $100,000, BWH paid $384,000, and MGH paid $515,000. Each entity will provide workforce training as part of a corrective action plan that will include OCR’s guidance on disclosures to film and media, according to OCR. Boston Medical Center's resolution agreement can be accessed here; Brigham and Women’s Hospital's resolution agreement can be found here; and Massachusetts General Hospital's agreement can be found here.

This is actually the second time a hospital has been fined by OCR as the result of allowing a film crew on premise to film a TV series, with the first HIPAA fine also involving the filming of an ABC medical documentary television series. As reported by Healthcare Informatics, In April 2016, New York Presbyterian Hospital (NYP) agreed to pay $2.2 million to settle potential HIPAA violations in association with the filming of “NY Med.”

According to OCR announcement about the settlement with NYP, the hospital, based in Manhattan, violated HIPAA rules for the “egregious disclosure of two patients’ PHI to film crews and staff during the filming of 'NY Med,' an ABC television series.” OCR also stated the NYP did not first obtain authorization from the patients. “In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop.”

The OCR director at the time, Jocelyn Samuels, said in a statement, “This case sends an important message that OCR will not permit covered entities to compromise their patients’ privacy by allowing news or television crews to film the patients without their authorization. We take seriously all complaints filed by individuals, and will seek the necessary remedies to ensure that patients’ privacy is fully protected.” 

OCR’s guidance on disclosures to film and media can be found here.

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Independence Blue Cross Notifies 17K Patients of Breach

September 19, 2018
by Rajiv Leventhal, Managing Editor
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The Philadelphia-based health insurer Independence Blue Cross is notifying about 17,000 of its members that some of their protected health information (PHI) has been exposed online and has potentially been accessed by unauthorized individuals.

According to an article in HIPAA Journal, Independence Blue Cross said that its privacy office was informed about the exposed information on July 19 and then immediately launched an investigation.

The insurer said that an employee had uploaded a file containing plan members’ protected health information to a public-facing website on April 23. The file remained accessible until July 20 when it was removed from the website.

According to the report, the information contained in the file was limited, and no financial information or Social Security numbers were exposed. Affected plan members only had their name, diagnosis codes, provider information, date of birth, and information used for processing claims exposed, HIPAA Journal reported.

The investigators were not able to determine whether any unauthorized individuals accessed the file during the time it was on the website, and no reports have been received to date to suggest any protected health information has been misused.

A statement from the health insurer noted that the breach affects certain Independence Blue Cross members and members of its subsidiaries AmeriHealth HMO and AmeriHealth Insurance Co. of New Jersey. Fewer than 1 percent of total plan members were affected by the breach.

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